Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $150.35 / $171.88 / $182.85	Facility	26	$150.35	$171.88	$182.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $302.58 / $487.24 / $530.04	Professional		$302.58	$487.24	$530.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.34 / $147.27 / $235.38	Professional	26	$102.34	$147.27	$235.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $212.09 / $328.03 / $385.70	Professional	TC	$212.09	$328.03	$385.70
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $445.77 / $459.22 / $688.71	Professional		$445.77	$459.22	$688.71
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $124.61 / $184.21 / $205.71	Professional	26	$124.61	$184.21	$205.71
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $275.00 / $275.00 / $597.00	Professional	TC	$275.00	$275.00	$597.00
BCBS Facility/Professional Professional Modifier Low / Median / High Price $422.14 / $558.71 / $620.79	Professional		$422.14	$558.71	$620.79
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $121.71 / $161.09 / $178.99	Professional	26	$121.71	$161.09	$178.99
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $300.42 / $397.62 / $441.80	Professional	TC	$300.42	$397.62	$441.80
CareSource Facility/Professional Professional Modifier Low / Median / High Price $109.50 / $299.20 / $470.93	Professional		$109.50	$299.20	$470.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $356.34 / $624.60 / $954.50	Professional		$356.34	$624.60	$954.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $108.57 / $161.38 / $242.19	Professional	26	$108.57	$161.38	$242.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $253.62 / $468.31 / $719.23	Professional	TC	$253.62	$468.31	$719.23
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $258.75 / $512.64 / $792.02	Professional		$258.75	$512.64	$792.02
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $202.31 / $214.96 / $236.57	Professional	26	$202.31	$214.96	$236.57
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $374.50 / $374.50 / $686.55	Professional	TC	$374.50	$374.50	$686.55
United Facility/Professional Professional Modifier Low / Median / High Price $397.71 / $541.24 / $811.37	Professional		$397.71	$541.24	$811.37
United Facility/Professional Professional Modifier 26 Low / Median / High Price $107.44 / $137.66 / $217.62	Professional	26	$107.44	$137.66	$217.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $286.98 / $420.94 / $604.57	Professional	TC	$286.98	$420.94	$604.57