Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $82.48 / $126.35 / $364.18	Facility	26	$82.48	$126.35	$364.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $193.50 / $275.87 / $345.80	Professional		$193.50	$275.87	$345.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.75 / $108.79 / $213.07	Professional	26	$74.75	$108.79	$213.07
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $120.64 / $149.52 / $212.21	Professional	TC	$120.64	$149.52	$212.21
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $162.11 / $283.55 / $313.06	Professional		$162.11	$283.55	$313.06
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $61.50 / $132.61 / $151.05	Professional	26	$61.50	$132.61	$151.05
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $86.04 / $156.83 / $172.08	Professional	TC	$86.04	$156.83	$172.08
BCBS Facility/Professional Professional Modifier Low / Median / High Price $194.37 / $257.26 / $285.83	Professional		$194.37	$257.26	$285.83
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $89.49 / $118.44 / $131.60	Professional	26	$89.49	$118.44	$131.60
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $104.88 / $138.82 / $154.24	Professional	TC	$104.88	$138.82	$154.24
CareSource Facility/Professional Professional Modifier Low / Median / High Price $80.41 / $116.70 / $212.11	Professional		$80.41	$116.70	$212.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $186.61 / $281.51 / $388.88	Professional		$186.61	$281.51	$388.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $78.84 / $118.67 / $177.75	Professional	26	$78.84	$118.67	$177.75
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $103.57 / $154.86 / $215.63	Professional	TC	$103.57	$154.86	$215.63
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $326.08 / $326.08 / $360.02	Professional		$326.08	$326.08	$360.02
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $141.21 / $157.41 / $193.20	Professional	26	$141.21	$157.41	$193.20
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $161.68 / $180.35 / $197.89	Professional	TC	$161.68	$180.35	$197.89
United Facility/Professional Professional Modifier Low / Median / High Price $186.93 / $252.28 / $375.85	Professional		$186.93	$252.28	$375.85
United Facility/Professional Professional Modifier 26 Low / Median / High Price $79.27 / $104.16 / $160.44	Professional	26	$79.27	$104.16	$160.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $99.21 / $144.01 / $205.27	Professional	TC	$99.21	$144.01	$205.27