Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.33 / $58.00 / $100.77	Facility	26	$52.33	$58.00	$100.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $65.23 / $184.41 / $688.75	Professional		$65.23	$184.41	$688.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.61 / $65.23 / $246.46	Professional	26	$46.61	$65.23	$246.46
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $200.41 / $200.41 / $200.41	Professional	50	$200.41	$200.41	$200.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $110.45 / $201.03 / $598.00	Professional	TC	$110.45	$201.03	$598.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $92.08 / $121.37 / $242.02	Professional		$92.08	$121.37	$242.02
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $34.88 / $48.98 / $74.44	Professional	26	$34.88	$48.98	$74.44
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $81.63 / $81.63 / $182.00	Professional	TC	$81.63	$81.63	$182.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $146.78 / $194.93 / $436.47	Professional		$146.78	$194.93	$436.47
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $49.69 / $63.94 / $113.08	Professional	26	$49.69	$63.94	$113.08
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $220.17 / $292.39 / $654.70	Professional	50	$220.17	$292.39	$654.70
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $97.08 / $130.59 / $335.70	Professional	TC	$97.08	$130.59	$335.70
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.02 / $54.02 / $54.02	Facility	26	$54.02	$54.02	$54.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $139.93 / $253.33 / $444.68	Professional		$139.93	$253.33	$444.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.32 / $67.76 / $124.66	Professional	26	$41.32	$67.76	$124.66
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $231.34 / $231.34 / $231.34	Professional	50	$231.34	$231.34	$231.34
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $101.83 / $182.99 / $333.57	Professional	TC	$101.83	$182.99	$333.57
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $341.52 / $442.24 / $442.24	Facility	26	$341.52	$442.24	$442.24
Medica Facility/Professional Professional Modifier Low / Median / High Price $180.88 / $271.39 / $1,378.78	Professional		$180.88	$271.39	$1,378.78
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $51.05 / $69.00 / $300.10	Professional	26	$51.05	$69.00	$300.10
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $129.00 / $208.45 / $1,103.98	Professional	TC	$129.00	$208.45	$1,103.98
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $278.32 / $278.32 / $278.32	Professional		$278.32	$278.32	$278.32
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $85.61 / $85.61 / $85.61	Professional	26	$85.61	$85.61	$85.61
United Facility/Professional Professional Modifier Low / Median / High Price $175.62 / $244.62 / $412.78	Professional		$175.62	$244.62	$412.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.20 / $61.15 / $109.09	Professional	26	$48.20	$61.15	$109.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $117.25 / $175.88 / $289.22	Professional	TC	$117.25	$175.88	$289.22