Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $161.74 / $161.74 / $278.43	Facility	26	$161.74	$161.74	$278.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $734.13 / $878.87 / $3,803.00	Professional		$734.13	$878.87	$3,803.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $123.67 / $161.74 / $622.05	Professional	26	$123.67	$161.74	$622.05
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $276.43 / $388.81 / $579.42	Professional	52	$276.43	$388.81	$579.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $545.89 / $683.99 / $1,848.52	Professional	TC	$545.89	$683.99	$1,848.52
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $751.83 / $1,010.50 / $1,253.05	Professional		$751.83	$1,010.50	$1,253.05
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $150.35 / $196.27 / $250.58	Professional	26	$150.35	$196.27	$250.58
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $814.24 / $814.24 / $814.24	Professional	TC	$814.24	$814.24	$814.24
BCBS Facility/Professional Professional Modifier Low / Median / High Price $652.32 / $863.36 / $863.36	Professional		$652.32	$863.36	$863.36
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $138.37 / $183.14 / $183.14	Professional	26	$138.37	$183.14	$183.14
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $513.94 / $680.22 / $680.22	Professional	TC	$513.94	$680.22	$680.22
CareSource Facility/Professional Professional Modifier Low / Median / High Price $141.38 / $596.63 / $802.98	Professional		$141.38	$596.63	$802.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $650.00 / $921.64 / $1,291.45	Professional		$650.00	$921.64	$1,291.45
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $143.56 / $196.32 / $314.60	Professional	26	$143.56	$196.32	$314.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $500.00 / $715.18 / $974.21	Professional	TC	$500.00	$715.18	$974.21
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $864.60 / $1,162.08 / $1,162.08	Professional		$864.60	$1,162.08	$1,162.08
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $172.90 / $225.71 / $288.17	Professional	26	$172.90	$225.71	$288.17
United Facility/Professional Professional Modifier Low / Median / High Price $499.65 / $769.57 / $1,161.16	Professional		$499.65	$769.57	$1,161.16
United Facility/Professional Professional Modifier 26 Low / Median / High Price $104.65 / $166.08 / $285.20	Professional	26	$104.65	$166.08	$285.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $424.49 / $669.40 / $947.92	Professional	TC	$424.49	$669.40	$947.92