Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $100.00 / $123.03	Facility	26	$85.11	$100.00	$123.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $489.78 / $1,047.13	Professional		$316.23	$489.78	$1,047.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $75.86 / $204.17	Professional	26	$64.57	$75.86	$204.17
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $398.11 / $575.44	Professional	TC	$269.15	$398.11	$575.44
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $416.87 / $645.65	Professional		$309.03	$416.87	$645.65
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $74.13 / $120.23	Professional	26	$57.54	$74.13	$120.23
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $501.19 / $630.96	Professional	TC	$323.59	$501.19	$630.96
BCBS Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $524.81 / $676.08	Professional		$457.09	$524.81	$676.08
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $93.33 / $120.23	Professional	26	$81.28	$93.33	$120.23
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $371.54 / $426.58 / $549.54	Professional	TC	$371.54	$426.58	$549.54
CareSource Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $691.83 / $870.96	Professional		$169.82	$691.83	$870.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $588.84 / $831.76	Professional		$416.87	$588.84	$831.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $107.15 / $154.88	Professional	26	$77.62	$107.15	$154.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $346.74 / $478.63 / $676.08	Professional	TC	$346.74	$478.63	$676.08
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $707.95 / $724.44 / $794.33	Professional		$707.95	$724.44	$794.33
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $117.49 / $162.18	Professional	26	$79.43	$117.49	$162.18
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $575.44 / $575.44 / $724.44	Professional	TC	$575.44	$575.44	$724.44
United Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $512.86 / $851.14	Professional		$416.87	$512.86	$851.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $89.13 / $158.49	Professional	26	$70.79	$89.13	$158.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $338.84 / $416.87 / $645.65	Professional	TC	$338.84	$416.87	$645.65