Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $113.71 / $158.04 / $168.98	Facility	26	$113.71	$158.04	$168.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $383.50 / $512.36 / $782.00	Professional		$383.50	$512.36	$782.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $91.25 / $133.71 / $248.04	Professional	26	$91.25	$133.71	$248.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $273.45 / $421.11 / $657.20	Professional	TC	$273.45	$421.11	$657.20
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $636.51 / $636.51 / $636.51	Professional		$636.51	$636.51	$636.51
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $100.53 / $170.57 / $190.47	Professional	26	$100.53	$170.57	$190.47
BCBS Facility/Professional Professional Modifier Low / Median / High Price $378.66 / $501.17 / $556.85	Professional		$378.66	$501.17	$556.85
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $111.91 / $148.12 / $164.58	Professional	26	$111.91	$148.12	$164.58
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $266.74 / $353.04 / $392.27	Professional	TC	$266.74	$353.04	$392.27
CareSource Facility/Professional Professional Modifier Low / Median / High Price $101.39 / $276.37 / $435.26	Professional		$101.39	$276.37	$435.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $387.32 / $615.69 / $889.89	Professional		$387.32	$615.69	$889.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $98.81 / $149.11 / $222.22	Professional	26	$98.81	$149.11	$222.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $279.37 / $442.78 / $710.96	Professional	TC	$279.37	$442.78	$710.96
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $731.99 / $731.99 / $731.99	Professional		$731.99	$731.99	$731.99
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $132.35 / $196.16 / $219.04	Professional	26	$132.35	$196.16	$219.04
United Facility/Professional Professional Modifier Low / Median / High Price $370.28 / $570.51 / $790.42	Professional		$370.28	$570.51	$790.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $99.95 / $129.63 / $201.39	Professional	26	$99.95	$129.63	$201.39
United Facility/Professional Professional Modifier TC Low / Median / High Price $269.58 / $441.72 / $567.85	Professional	TC	$269.58	$441.72	$567.85