Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $38.90 / $95.50 / $416.87	Facility		$38.90	$95.50	$416.87
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.91 / $10.47 / $17.38	Facility	26	$8.91	$10.47	$17.38
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $27.54 / $47.86 / $204.17	Facility	TC	$27.54	$47.86	$204.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $13.18 / $33.11 / $66.07	Professional		$13.18	$33.11	$66.07
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.76 / $9.55 / $25.70	Professional	26	$6.76	$9.55	$25.70
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $48.98 / $66.07 / $162.18	Professional	50	$48.98	$66.07	$162.18
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $17.78 / $21.38 / $58.88	Professional	52	$17.78	$21.38	$58.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $25.70 / $41.69	Professional	TC	$18.20	$25.70	$41.69
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $5.62 / $22.91 / $30.20	Professional		$5.62	$22.91	$30.20
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.75 / $6.92 / $12.02	Professional	26	$5.75	$6.92	$12.02
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $42.66 / $42.66 / $42.66	Professional	50	$42.66	$42.66	$42.66
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $14.13 / $21.88 / $33.11	Professional	TC	$14.13	$21.88	$33.11
BCBS Facility/Professional Facility Modifier Low / Median / High Price $77.62 / $104.71 / $147.91	Facility		$77.62	$104.71	$147.91
BCBS Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $47.86 / $47.86	Professional		$47.86	$47.86	$47.86
Cigna Facility/Professional Facility Modifier Low / Median / High Price $74.13 / $107.15 / $194.98	Facility		$74.13	$107.15	$194.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $22.91 / $36.31 / $63.10	Professional		$22.91	$36.31	$63.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.76 / $10.47 / $17.78	Professional	26	$6.76	$10.47	$17.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $28.18 / $50.12	Professional	TC	$15.85	$28.18	$50.12
Medica Facility/Professional Facility Modifier Low / Median / High Price $30.90 / $38.90 / $81.28	Facility		$30.90	$38.90	$81.28
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $18.20 / $18.20 / $100.00	Facility	26	$18.20	$18.20	$100.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $51.29 / $51.29 / $109.65	Facility	TC	$51.29	$51.29	$109.65
Medica Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $37.15 / $208.93	Professional		$26.92	$37.15	$208.93
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $10.23 / $67.61	Professional	26	$7.59	$10.23	$67.61
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $26.30 / $158.49	Professional	TC	$19.05	$26.30	$158.49
United Facility/Professional Facility Modifier Low / Median / High Price $18.20 / $66.07 / $97.72	Facility		$18.20	$66.07	$97.72
United Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $32.36 / $51.29	Professional		$26.92	$32.36	$51.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $8.71 / $13.80	Professional	26	$7.59	$8.71	$13.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $22.91 / $37.15	Professional	TC	$19.05	$22.91	$37.15