Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.72 / $14.45 / $33.88	Facility	26	$10.72	$14.45	$33.88
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $33.11 / $63.10 / $338.84	Facility	TC	$33.11	$63.10	$338.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $16.60 / $53.70 / $194.98	Professional		$16.60	$53.70	$194.98
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.77 / $20.89 / $54.95	Professional	26	$9.77	$20.89	$54.95
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $32.36 / $112.20 / $257.04	Professional	50	$32.36	$112.20	$257.04
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $43.65 / $43.65 / $43.65	Professional	52	$43.65	$43.65	$43.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $48.98 / $102.33	Professional	TC	$28.18	$48.98	$102.33
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $38.02 / $70.79	Professional		$30.90	$38.02	$70.79
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $10.72 / $19.05	Professional	26	$8.13	$10.72	$19.05
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $45.71 / $58.88 / $120.23	Professional	50	$45.71	$58.88	$120.23
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $38.90 / $60.26	Professional	TC	$28.84	$38.90	$60.26
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $47.86 / $79.43	Professional		$37.15	$47.86	$79.43
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $13.80 / $22.91	Professional	26	$10.96	$13.80	$22.91
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $56.23 / $70.79 / $117.49	Professional	50	$56.23	$70.79	$117.49
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $33.11 / $56.23	Professional	TC	$26.30	$33.11	$56.23
BCBS Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $53.70 / $66.07	Professional		$50.12	$53.70	$66.07
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $12.30 / $18.20	Professional	26	$12.02	$12.30	$18.20
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $41.69 / $52.48	Professional	TC	$38.02	$41.69	$52.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $53.70 / $100.00	Professional		$34.67	$53.70	$100.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.77 / $15.14 / $27.54	Professional	26	$9.77	$15.14	$27.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $38.90 / $77.62	Professional	TC	$25.12	$38.90	$77.62
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $25.70 / $100.00 / $100.00	Facility	26	$25.70	$100.00	$100.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $77.62 / $165.96 / $165.96	Facility	TC	$77.62	$165.96	$165.96
Medica Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $57.54 / $295.12	Professional		$38.02	$57.54	$295.12
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $16.98 / $87.10	Professional	26	$10.96	$16.98	$87.10
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $42.66 / $229.09	Professional	TC	$27.54	$42.66	$229.09
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $72.44 / $85.11	Professional		$67.61	$72.44	$85.11
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $20.42 / $30.20	Professional	26	$19.95	$20.42	$30.20
Qualchoice Facility/Professional Professional Modifier 50 Low / Median / High Price $109.65 / $109.65 / $120.23	Professional	50	$109.65	$109.65	$120.23
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $56.23 / $60.26	Professional	TC	$51.29	$56.23	$60.26
United Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $46.77 / $75.86	Professional		$37.15	$46.77	$75.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $12.59 / $21.38	Professional	26	$10.47	$12.59	$21.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $33.88 / $57.54	Professional	TC	$26.30	$33.88	$57.54