Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.99 / $46.62 / $62.87	Facility	26	$40.99	$46.62	$62.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $100.22 / $144.97 / $218.67	Professional		$100.22	$144.97	$218.67
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.31 / $43.83 / $76.93	Professional	26	$28.31	$43.83	$76.93
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $41.80 / $70.93 / $80.54	Professional	52	$41.80	$70.93	$80.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $65.70 / $98.88 / $141.41	Professional	TC	$65.70	$98.88	$141.41
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $126.82 / $177.82 / $198.07	Professional		$126.82	$177.82	$198.07
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $24.60 / $51.99 / $55.52	Professional	26	$24.60	$51.99	$55.52
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $23.05 / $23.05 / $23.05	Professional	52	$23.05	$23.05	$23.05
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $114.96 / $127.28 / $135.25	Professional	TC	$114.96	$127.28	$135.25
BCBS Facility/Professional Professional Modifier Low / Median / High Price $116.74 / $154.51 / $171.68	Professional		$116.74	$154.51	$171.68
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $35.70 / $47.25 / $52.50	Professional	26	$35.70	$47.25	$52.50
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $81.04 / $107.26 / $119.18	Professional	TC	$81.04	$107.26	$119.18
CareSource Facility/Professional Professional Modifier Low / Median / High Price $32.15 / $83.21 / $145.15	Professional		$32.15	$83.21	$145.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $96.70 / $150.19 / $219.71	Professional		$96.70	$150.19	$219.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.87 / $47.42 / $64.70	Professional	26	$27.87	$47.42	$64.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $66.25 / $101.48 / $154.13	Professional	TC	$66.25	$101.48	$154.13
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $145.84 / $204.49 / $218.75	Professional		$145.84	$204.49	$218.75
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $42.15 / $59.79 / $69.47	Professional	26	$42.15	$59.79	$69.47
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $132.19 / $146.37 / $155.54	Professional	TC	$132.19	$146.37	$155.54
United Facility/Professional Professional Modifier Low / Median / High Price $100.77 / $132.72 / $207.57	Professional		$100.77	$132.72	$207.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.88 / $38.90 / $63.67	Professional	26	$31.88	$38.90	$63.67
United Facility/Professional Professional Modifier TC Low / Median / High Price $72.12 / $90.82 / $145.37	Professional	TC	$72.12	$90.82	$145.37