Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.59 / $14.02 / $32.15	Facility	26	$13.59	$14.02	$32.15
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $37.22 / $234.21 / $439.66	Facility	TC	$37.22	$234.21	$439.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $46.57 / $57.45 / $215.20	Professional		$46.57	$57.45	$215.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.38 / $16.14 / $39.29	Professional	26	$12.38	$16.14	$39.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.85 / $37.56 / $94.82	Professional	TC	$30.85	$37.56	$94.82
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $40.13 / $42.70 / $75.29	Professional		$40.13	$42.70	$75.29
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.43 / $14.35 / $21.02	Professional	26	$10.43	$14.35	$21.02
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $33.38 / $52.23 / $55.27	Professional	TC	$33.38	$52.23	$55.27
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $45.43 / $56.17 / $98.11	Professional		$45.43	$56.17	$98.11
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.90 / $18.38 / $30.46	Professional	26	$14.90	$18.38	$30.46
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $68.14 / $84.25 / $147.16	Professional	50	$68.14	$84.25	$147.16
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $30.53 / $38.19 / $66.61	Professional	TC	$30.53	$38.19	$66.61
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.14 / $16.14 / $16.14	Facility	26	$16.14	$16.14	$16.14
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $44.74 / $44.74 / $44.74	Facility	TC	$44.74	$44.74	$44.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $40.29 / $65.13 / $105.06	Professional		$40.29	$65.13	$105.06
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.39 / $20.23 / $31.32	Professional	26	$12.39	$20.23	$31.32
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.91 / $44.33 / $78.63	Professional	TC	$28.91	$44.33	$78.63
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $33.22 / $70.00 / $70.00	Facility	26	$33.22	$70.00	$70.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $84.96 / $181.68 / $181.68	Facility	TC	$84.96	$181.68	$181.68
Medica Facility/Professional Professional Modifier Low / Median / High Price $47.23 / $63.23 / $345.18	Professional		$47.23	$63.23	$345.18
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $14.41 / $18.48 / $89.67	Professional	26	$14.41	$18.48	$89.67
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $32.11 / $42.07 / $255.46	Professional	TC	$32.11	$42.07	$255.46
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $25.63 / $25.63 / $25.63	Professional	26	$25.63	$25.63	$25.63
United Facility/Professional Professional Modifier Low / Median / High Price $47.23 / $57.72 / $99.40	Professional		$47.23	$57.72	$99.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.22 / $17.63 / $28.44	Professional	26	$14.22	$17.63	$28.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $31.90 / $41.01 / $69.01	Professional	TC	$31.90	$41.01	$69.01