Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.57 / $91.20 / $97.72	Facility	26	$64.57	$91.20	$97.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $134.90 / $501.19	Professional		$91.20	$134.90	$501.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $162.18 / $933.25	Professional	26	$56.23	$162.18	$933.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $69.18 / $190.55	Professional	TC	$43.65	$69.18	$190.55
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $95.50 / $223.87	Professional		$93.33	$95.50	$223.87
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $63.10 / $97.72	Professional	26	$45.71	$63.10	$97.72
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $95.50 / $95.50	Professional	TC	$95.50	$95.50	$95.50
BCBS Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $144.54 / $186.21	Professional		$125.89	$144.54	$186.21
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $70.79 / $91.20	Professional	26	$61.66	$70.79	$91.20
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $72.44 / $93.33	Professional	TC	$63.10	$72.44	$93.33
CareSource Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $134.90 / $269.15	Professional		$131.83	$134.90	$269.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $218.78 / $331.13	Professional		$173.78	$218.78	$331.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $97.72 / $138.04	Professional	26	$64.57	$97.72	$138.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $114.82 / $190.55	Professional	TC	$74.13	$114.82	$190.55
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $218.78 / $257.04	Professional		$218.78	$218.78	$257.04
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $109.65 / $128.82	Professional	26	$89.13	$109.65	$128.82
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $112.20 / $112.20	Professional	TC	$112.20	$112.20	$112.20
United Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $173.78 / $275.42	Professional		$112.20	$173.78	$275.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $67.61 / $112.20	Professional	26	$54.95	$67.61	$112.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $91.20 / $158.49	Professional	TC	$58.88	$91.20	$158.49