Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.53 / $55.53 / $83.30	Facility	26	$55.53	$55.53	$83.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $124.73 / $169.20 / $229.39	Professional		$124.73	$169.20	$229.39
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.71 / $55.22 / $103.02	Professional	26	$32.71	$55.22	$103.02
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $31.25 / $31.25 / $31.25	Professional	52	$31.25	$31.25	$31.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.95 / $109.71 / $174.18	Professional	TC	$79.95	$109.71	$174.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $95.53 / $186.80 / $186.80	Professional		$95.53	$186.80	$186.80
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $33.29 / $52.40 / $53.44	Professional	26	$33.29	$52.40	$53.44
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $186.80 / $186.80 / $190.53	Professional	52	$186.80	$186.80	$190.53
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $134.40 / $134.40 / $134.40	Professional	TC	$134.40	$134.40	$134.40
BCBS Facility/Professional Professional Modifier Low / Median / High Price $185.48 / $185.48 / $185.48	Professional		$185.48	$185.48	$185.48
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $55.53 / $55.53 / $55.53	Professional	26	$55.53	$55.53	$55.53
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $129.94 / $129.94 / $129.94	Professional	TC	$129.94	$129.94	$129.94
CareSource Facility/Professional Professional Modifier Low / Median / High Price $35.35 / $90.38 / $145.04	Professional		$35.35	$90.38	$145.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $115.27 / $174.34 / $234.93	Professional		$115.27	$174.34	$234.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.51 / $51.40 / $70.76	Professional	26	$34.51	$51.40	$70.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $81.45 / $122.80 / $164.60	Professional	TC	$81.45	$122.80	$164.60
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $144.65 / $214.82 / $214.82	Professional		$144.65	$214.82	$214.82
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $60.26 / $62.23	Professional	26	$60.26	$60.26	$62.23
Qualchoice Facility/Professional Professional Modifier 52 Low / Median / High Price $219.11 / $219.11 / $219.11	Professional	52	$219.11	$219.11	$219.11
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $154.56 / $154.56 / $154.56	Professional	TC	$154.56	$154.56	$154.56
United Facility/Professional Professional Modifier Low / Median / High Price $122.80 / $171.36 / $236.94	Professional		$122.80	$171.36	$236.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.40 / $50.76 / $71.44	Professional	26	$35.40	$50.76	$71.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $86.97 / $129.06 / $179.95	Professional	TC	$86.97	$129.06	$179.95