Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.32 / $34.20 / $105.00	Facility	26	$32.32	$34.20	$105.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $97.11 / $119.52 / $313.86	Professional		$97.11	$119.52	$313.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.52 / $32.32 / $75.95	Professional	26	$22.52	$32.32	$75.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $74.47 / $91.07 / $120.31	Professional	TC	$74.47	$91.07	$120.31
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $112.30 / $112.30 / $187.17	Professional		$112.30	$112.30	$187.17
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $33.33 / $38.14 / $50.59	Professional	26	$33.33	$38.14	$50.59
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $81.95 / $97.12 / $152.85	Professional	TC	$81.95	$97.12	$152.85
BCBS Facility/Professional Professional Modifier Low / Median / High Price $100.41 / $132.88 / $132.88	Professional		$100.41	$132.88	$132.88
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $28.24 / $37.38 / $37.38	Professional	26	$28.24	$37.38	$37.38
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $72.17 / $95.52 / $95.52	Professional	TC	$72.17	$95.52	$95.52
CareSource Facility/Professional Professional Modifier Low / Median / High Price $24.06 / $71.47 / $119.84	Professional		$24.06	$71.47	$119.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.91 / $150.55 / $198.67	Professional		$102.91	$150.55	$198.67
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.43 / $39.02 / $55.88	Professional	26	$27.43	$39.02	$55.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $73.95 / $103.17 / $150.91	Professional	TC	$73.95	$103.17	$150.91
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $129.15 / $157.47 / $221.93	Professional		$129.15	$157.47	$221.93
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $34.90 / $43.86 / $60.33	Professional	26	$34.90	$43.86	$60.33
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $94.24 / $94.24 / $175.78	Professional	TC	$94.24	$94.24	$175.78
United Facility/Professional Professional Modifier Low / Median / High Price $87.60 / $125.06 / $189.17	Professional		$87.60	$125.06	$189.17
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.72 / $34.40 / $51.84	Professional	26	$23.72	$34.40	$51.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $63.74 / $94.28 / $135.75	Professional	TC	$63.74	$94.28	$135.75