Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.57 / $32.64 / $54.36	Facility	26	$26.57	$32.64	$54.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $49.47 / $83.95 / $256.08	Professional		$49.47	$83.95	$256.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.18 / $29.40 / $108.16	Professional	26	$24.18	$29.40	$108.16
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $24.44 / $27.89 / $324.00	Professional	52	$24.44	$27.89	$324.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.28 / $50.92 / $145.28	Professional	TC	$25.28	$50.92	$145.28
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $33.15 / $43.52 / $87.59	Professional		$33.15	$43.52	$87.59
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $20.14 / $28.37 / $42.89	Professional	26	$20.14	$28.37	$42.89
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $10.46 / $10.46 / $10.46	Professional	52	$10.46	$10.46	$10.46
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $80.97 / $98.25 / $150.65	Professional		$80.97	$98.25	$150.65
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $26.80 / $33.10 / $54.35	Professional	26	$26.80	$33.10	$54.35
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $46.72 / $60.54 / $100.29	Professional	TC	$46.72	$60.54	$100.29
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.97 / $30.97 / $30.97	Facility	26	$30.97	$30.97	$30.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $47.32 / $89.45 / $160.26	Professional		$47.32	$89.45	$160.26
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.51 / $35.04 / $63.82	Professional	26	$22.51	$35.04	$63.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.76 / $57.29 / $108.98	Professional	TC	$25.76	$57.29	$108.98
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $64.51 / $122.62 / $122.62	Facility	26	$64.51	$122.62	$122.62
Medica Facility/Professional Professional Modifier Low / Median / High Price $76.45 / $99.17 / $447.95	Professional		$76.45	$99.17	$447.95
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $26.63 / $34.79 / $265.83	Professional	26	$26.63	$34.79	$265.83
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $46.80 / $63.15 / $398.99	Professional	TC	$46.80	$63.15	$398.99
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $100.73 / $100.73 / $100.73	Professional		$100.73	$100.73	$100.73
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $12.37 / $12.37 / $49.48	Professional	26	$12.37	$12.37	$49.48
United Facility/Professional Professional Modifier Low / Median / High Price $72.43 / $89.11 / $151.24	Professional		$72.43	$89.11	$151.24
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.87 / $32.06 / $51.02	Professional	26	$25.87	$32.06	$51.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $43.26 / $56.49 / $86.51	Professional	TC	$43.26	$56.49	$86.51