Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.36 / $50.10 / $85.65	Facility	26	$43.36	$50.10	$85.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $140.18 / $258.32 / $784.76	Professional		$140.18	$258.32	$784.76
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.46 / $57.37 / $199.43	Professional	26	$38.46	$57.37	$199.43
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $64.88 / $80.45 / $137.50	Professional	52	$64.88	$80.45	$137.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $96.81 / $195.98 / $548.41	Professional	TC	$96.81	$195.98	$548.41
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $73.47 / $96.87 / $215.14	Professional		$73.47	$96.87	$215.14
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.12 / $42.31 / $57.75	Professional	26	$30.12	$42.31	$57.75
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $74.78 / $74.78 / $74.78	Professional	TC	$74.78	$74.78	$74.78
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $126.40 / $170.02 / $449.79	Professional		$126.40	$170.02	$449.79
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $42.38 / $55.86 / $118.33	Professional	26	$42.38	$55.86	$118.33
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $84.02 / $116.80 / $335.62	Professional	TC	$84.02	$116.80	$335.62
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.27 / $46.27 / $46.27	Facility	26	$46.27	$46.27	$46.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $111.28 / $216.12 / $440.19	Professional		$111.28	$216.12	$440.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.44 / $60.61 / $106.30	Professional	26	$35.44	$60.61	$106.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $78.39 / $157.50 / $333.56	Professional	TC	$78.39	$157.50	$333.56
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $295.27 / $379.28 / $379.28	Facility	26	$295.27	$379.28	$379.28
Medica Facility/Professional Professional Modifier Low / Median / High Price $141.47 / $268.00 / $1,413.47	Professional		$141.47	$268.00	$1,413.47
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $44.03 / $65.63 / $333.52	Professional	26	$44.03	$65.63	$333.52
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $96.93 / $189.10 / $1,220.00	Professional	TC	$96.93	$189.10	$1,220.00
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $73.75 / $73.75 / $73.75	Professional	26	$73.75	$73.75	$73.75
United Facility/Professional Professional Modifier Low / Median / High Price $137.10 / $202.67 / $356.52	Professional		$137.10	$202.67	$356.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.63 / $54.22 / $89.44	Professional	26	$39.63	$54.22	$89.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $93.35 / $126.59 / $249.90	Professional	TC	$93.35	$126.59	$249.90