Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $76.69 / $94.37 / $142.97	Facility	26	$76.69	$94.37	$142.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $145.07 / $337.92 / $1,336.35	Professional		$145.07	$337.92	$1,336.35
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.06 / $139.37 / $306.75	Professional	26	$66.06	$139.37	$306.75
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $1,218.00 / $1,218.00 / $1,218.00	Professional	50	$1,218.00	$1,218.00	$1,218.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $124.30 / $167.56 / $237.50	Professional	52	$124.30	$167.56	$237.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $176.33 / $305.00 / $917.81	Professional	TC	$176.33	$305.00	$917.81
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $117.08 / $154.13 / $307.23	Professional		$117.08	$154.13	$307.23
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $47.56 / $66.80 / $95.69	Professional	26	$47.56	$66.80	$95.69
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $119.31 / $119.31 / $253.00	Professional	TC	$119.31	$119.31	$253.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $211.47 / $276.11 / $813.63	Professional		$211.47	$276.11	$813.63
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $67.38 / $87.05 / $139.69	Professional	26	$67.38	$87.05	$139.69
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $317.20 / $414.16 / $1,220.44	Professional	50	$317.20	$414.16	$1,220.44
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $144.09 / $191.35 / $615.00	Professional	TC	$144.09	$191.35	$615.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $73.64 / $73.64 / $73.64	Facility	26	$73.64	$73.64	$73.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $176.80 / $362.72 / $798.28	Professional		$176.80	$362.72	$798.28
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.28 / $92.08 / $159.19	Professional	26	$56.28	$92.08	$159.19
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $301.29 / $301.29 / $301.29	Professional	50	$301.29	$301.29	$301.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $124.46 / $254.69 / $684.67	Professional	TC	$124.46	$254.69	$684.67
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $466.08 / $603.28 / $603.28	Facility	26	$466.08	$603.28	$603.28
Medica Facility/Professional Professional Modifier Low / Median / High Price $229.40 / $474.75 / $2,789.74	Professional		$229.40	$474.75	$2,789.74
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $65.77 / $95.00 / $542.85	Professional	26	$65.77	$95.00	$542.85
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $158.22 / $344.84 / $2,451.15	Professional	TC	$158.22	$344.84	$2,451.15
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $353.31 / $353.31 / $353.31	Professional		$353.31	$353.31	$353.31
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $116.55 / $116.55 / $116.55	Professional	26	$116.55	$116.55	$116.55
United Facility/Professional Professional Modifier Low / Median / High Price $226.01 / $332.02 / $819.77	Professional		$226.01	$332.02	$819.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.09 / $81.93 / $145.50	Professional	26	$64.09	$81.93	$145.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $152.68 / $220.23 / $549.79	Professional	TC	$152.68	$220.23	$549.79