Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.70 / $79.43 / $223.87	Facility	26	$53.70	$79.43	$223.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $158.49 / $524.81	Professional		$47.86	$158.49	$524.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $75.86 / $208.93	Professional	26	$44.67	$75.86	$208.93
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $199.53 / $199.53 / $199.53	Professional	50	$199.53	$199.53	$199.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $141.25 / $416.87	Professional	TC	$100.00	$141.25	$416.87
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $117.49 / $120.23	Professional		$112.20	$117.49	$120.23
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $50.12 / $77.62	Professional	26	$35.48	$50.12	$77.62
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $81.28 / $81.28	Professional	TC	$81.28	$81.28	$81.28
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $186.21 / $416.87	Professional		$147.91	$186.21	$416.87
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $63.10 / $107.15	Professional	26	$50.12	$63.10	$107.15
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $218.78 / $275.42 / $630.96	Professional	50	$218.78	$275.42	$630.96
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $128.82 / $295.12	Professional	TC	$97.72	$128.82	$295.12
BCBS Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $173.78 / $263.03	Professional		$169.82	$173.78	$263.03
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $56.23 / $79.43	Professional	26	$50.12	$56.23	$79.43
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $123.03 / $190.55	Professional	TC	$117.49	$123.03	$190.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $245.47 / $446.68	Professional		$147.91	$245.47	$446.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $67.61 / $128.82	Professional	26	$41.69	$67.61	$128.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $181.97 / $346.74	Professional	TC	$104.71	$181.97	$346.74
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $338.84 / $446.68 / $446.68	Facility	26	$338.84	$446.68	$446.68
Medica Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $269.15 / $1,380.38	Professional		$173.78	$269.15	$1,380.38
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $70.79 / $302.00	Professional	26	$45.71	$70.79	$302.00
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $204.17 / $1,096.48	Professional	TC	$117.49	$204.17	$1,096.48
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $275.42 / $281.84	Professional		$275.42	$275.42	$281.84
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $85.11 / $87.10	Professional	26	$85.11	$85.11	$87.10
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $190.55 / $190.55	Professional	TC	$190.55	$190.55	$190.55
United Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $223.87 / $363.08	Professional		$162.18	$223.87	$363.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $58.88 / $95.50	Professional	26	$45.71	$58.88	$95.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $158.49 / $263.03	Professional	TC	$112.20	$158.49	$263.03