Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $387.76 / $387.76 / $2,168.00	Facility		$387.76	$387.76	$2,168.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $118.50 / $118.50 / $118.50	Facility	26	$118.50	$118.50	$118.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $341.43 / $387.76 / $2,003.85	Professional		$341.43	$387.76	$2,003.85
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $118.50 / $127.31 / $184.18	Professional	26	$118.50	$127.31	$184.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $214.11 / $269.26 / $381.49	Professional	TC	$214.11	$269.26	$381.49
BCBS Facility/Professional Facility Modifier Low / Median / High Price $658.53 / $1,364.82 / $2,679.65	Facility		$658.53	$1,364.82	$2,679.65
BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $101.94 / $101.94 / $101.94	Facility	26	$101.94	$101.94	$101.94
BCBS Facility/Professional Professional Modifier Low / Median / High Price $565.59 / $982.95 / $1,401.57	Professional		$565.59	$982.95	$1,401.57
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $207.59 / $320.94 / $450.55	Professional	26	$207.59	$320.94	$450.55
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $426.11 / $704.15 / $1,025.69	Professional	TC	$426.11	$704.15	$1,025.69
Cigna Facility/Professional Facility Modifier Low / Median / High Price $970.29 / $1,375.99 / $3,310.13	Facility		$970.29	$1,375.99	$3,310.13
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $298.16 / $422.83 / $1,017.17	Facility	26	$298.16	$422.83	$1,017.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $730.11 / $1,243.68 / $1,751.62	Professional		$730.11	$1,243.68	$1,751.62
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $241.33 / $407.66 / $578.98	Professional	26	$241.33	$407.66	$578.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $488.78 / $852.25 / $1,172.64	Professional	TC	$488.78	$852.25	$1,172.64
Health Partners Facility/Professional Facility Modifier Low / Median / High Price $788.77 / $1,257.98 / $2,606.40	Facility		$788.77	$1,257.98	$2,606.40
Health Partners Facility/Professional Facility Modifier 26 Low / Median / High Price $242.38 / $386.57 / $800.93	Facility	26	$242.38	$386.57	$800.93
Health Partners Facility/Professional Professional Modifier Low / Median / High Price $642.79 / $1,100.00 / $1,457.74	Professional		$642.79	$1,100.00	$1,457.74
Health Partners Facility/Professional Professional Modifier 26 Low / Median / High Price $212.47 / $363.60 / $481.84	Professional	26	$212.47	$363.60	$481.84
Health Partners Facility/Professional Professional Modifier TC Low / Median / High Price $430.32 / $736.41 / $975.90	Professional	TC	$430.32	$736.41	$975.90
Medica Facility/Professional Facility Modifier Low / Median / High Price $529.94 / $747.02 / $2,872.00	Facility		$529.94	$747.02	$2,872.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $480.62 / $950.35 / $2,000.28	Professional		$480.62	$950.35	$2,000.28
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $169.58 / $330.22 / $662.94	Professional	26	$169.58	$330.22	$662.94
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $302.01 / $633.76 / $1,337.34	Professional	TC	$302.01	$633.76	$1,337.34
United Facility/Professional Facility Modifier Low / Median / High Price $1,755.00 / $2,872.00 / $4,241.00	Facility		$1,755.00	$2,872.00	$4,241.00
United Facility/Professional Professional Modifier Low / Median / High Price $501.91 / $1,060.98 / $1,486.41	Professional		$501.91	$1,060.98	$1,486.41
United Facility/Professional Professional Modifier 26 Low / Median / High Price $166.27 / $353.90 / $509.15	Professional	26	$166.27	$353.90	$509.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $319.58 / $707.08 / $1,027.10	Professional	TC	$319.58	$707.08	$1,027.10