Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $162.18 / $162.18 / $275.42	Facility	26	$162.18	$162.18	$275.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $549.54 / $758.58 / $1,258.93	Professional		$549.54	$758.58	$1,258.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $169.82 / $371.54	Professional	26	$114.82	$169.82	$371.54
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $199.53 / $645.65 / $1,258.93	Professional	52	$199.53	$645.65	$1,258.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $436.52 / $588.84 / $933.25	Professional	TC	$436.52	$588.84	$933.25
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $588.84 / $912.01	Professional		$537.03	$588.84	$912.01
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $138.04 / $194.98	Professional	26	$107.15	$138.04	$194.98
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $323.59 / $512.86	Professional	TC	$323.59	$323.59	$512.86
BCBS Facility/Professional Professional Modifier Low / Median / High Price $645.65 / $645.65 / $870.96	Professional		$645.65	$645.65	$870.96
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $138.04 / $181.97	Professional	26	$138.04	$138.04	$181.97
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $512.86 / $512.86 / $676.08	Professional	TC	$512.86	$512.86	$676.08
CareSource Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $645.65 / $933.25	Professional		$134.90	$645.65	$933.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $645.65 / $912.01 / $1,288.25	Professional		$645.65	$912.01	$1,288.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $190.55 / $316.23	Professional	26	$141.25	$190.55	$316.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $501.19 / $724.44 / $977.24	Professional	TC	$501.19	$724.44	$977.24
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $173.78 / $213.80 / $316.23	Professional	26	$173.78	$213.80	$316.23
United Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $758.58 / $1,122.02	Professional		$524.81	$758.58	$1,122.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $154.88 / $269.15	Professional	26	$104.71	$154.88	$269.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $416.87 / $602.56 / $870.96	Professional	TC	$416.87	$602.56	$870.96