Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $107.15 / $107.15 / $128.82	Facility	26	$107.15	$107.15	$128.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $275.42 / $575.44	Professional		$204.17	$275.42	$575.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $93.33 / $169.82	Professional	26	$67.61	$93.33	$169.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $165.96 / $251.19	Professional	TC	$123.03	$165.96	$251.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $213.80 / $302.00	Professional		$194.98	$213.80	$302.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $100.00 / $165.96	Professional	26	$72.44	$100.00	$165.96
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $288.40 / $288.40	Professional	TC	$288.40	$288.40	$288.40
BCBS Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $239.88 / $316.23	Professional		$239.88	$239.88	$316.23
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $93.33 / $123.03	Professional	26	$93.33	$93.33	$123.03
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $144.54 / $194.98	Professional	TC	$144.54	$144.54	$194.98
CareSource Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $151.36 / $302.00	Professional		$79.43	$151.36	$302.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $338.84 / $478.63	Professional		$229.09	$338.84	$478.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $125.89 / $165.96	Professional	26	$85.11	$125.89	$165.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $199.53 / $295.12	Professional	TC	$141.25	$199.53	$295.12
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $346.74 / $549.54	Professional		$309.03	$346.74	$549.54
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $134.90 / $208.93	Professional	26	$95.50	$134.90	$208.93
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $331.13 / $331.13 / $331.13	Professional	TC	$331.13	$331.13	$331.13
United Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $288.40 / $446.68	Professional		$208.93	$288.40	$446.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $107.15 / $173.78	Professional	26	$79.43	$107.15	$173.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $173.78 / $281.84	Professional	TC	$128.82	$173.78	$281.84