Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.85 / $15.86 / $18.71	Facility	26	$15.85	$15.86	$18.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $70.56 / $103.96 / $171.83	Professional		$70.56	$103.96	$171.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.54 / $15.79 / $27.90	Professional	26	$10.54	$15.79	$27.90
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $35.28 / $51.98 / $85.91	Professional	52	$35.28	$51.98	$85.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.14 / $88.10 / $145.50	Professional	TC	$61.14	$88.10	$145.50
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $60.67 / $109.97 / $139.09	Professional		$60.67	$109.97	$139.09
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $9.22 / $16.44 / $23.71	Professional	26	$9.22	$16.44	$23.71
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $23.20 / $23.20 / $23.20	Professional	52	$23.20	$23.20	$23.20
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $119.86 / $119.86 / $119.86	Professional	TC	$119.86	$119.86	$119.86
BCBS Facility/Professional Professional Modifier Low / Median / High Price $81.59 / $107.99 / $107.99	Professional		$81.59	$107.99	$107.99
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.80 / $16.95 / $16.95	Professional	26	$12.80	$16.95	$16.95
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $68.79 / $91.04 / $91.04	Professional	TC	$68.79	$91.04	$91.04
CareSource Facility/Professional Professional Modifier Low / Median / High Price $11.28 / $68.54 / $99.48	Professional		$11.28	$68.54	$99.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $79.70 / $122.06 / $150.63	Professional		$79.70	$122.06	$150.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.53 / $17.32 / $24.13	Professional	26	$11.53	$17.32	$24.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $67.20 / $106.03 / $132.99	Professional	TC	$67.20	$106.03	$132.99
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $126.47 / $131.76 / $159.94	Professional		$126.47	$131.76	$159.94
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $16.35 / $20.55 / $27.27	Professional	26	$16.35	$20.55	$27.27
Qualchoice Facility/Professional Professional Modifier 52 Low / Median / High Price $26.68 / $26.68 / $26.68	Professional	52	$26.68	$26.68	$26.68
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $137.84 / $137.84 / $137.84	Professional	TC	$137.84	$137.84	$137.84
United Facility/Professional Professional Modifier Low / Median / High Price $75.19 / $108.74 / $147.71	Professional		$75.19	$108.74	$147.71
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.27 / $15.95 / $23.65	Professional	26	$11.27	$15.95	$23.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $64.06 / $93.12 / $138.36	Professional	TC	$64.06	$93.12	$138.36