Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.67 / $41.77 / $72.67	Facility	26	$33.67	$41.77	$72.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $86.27 / $104.98 / $292.50	Professional		$86.27	$104.98	$292.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.64 / $36.20 / $94.90	Professional	26	$30.64	$36.20	$94.90
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $88.37 / $291.00 / $817.50	Professional	50	$88.37	$291.00	$817.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $59.50 / $69.40 / $161.36	Professional	TC	$59.50	$69.40	$161.36
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $70.83 / $76.11 / $106.25	Professional		$70.83	$76.11	$106.25
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.90 / $48.57 / $78.16	Professional	26	$25.90	$48.57	$78.16
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $86.85 / $114.16 / $228.04	Professional	50	$86.85	$114.16	$228.04
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $97.77 / $120.27 / $194.97	Professional		$97.77	$120.27	$194.97
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.14 / $42.36 / $68.47	Professional	26	$36.14	$42.36	$68.47
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $146.65 / $180.40 / $292.45	Professional	50	$146.65	$180.40	$292.45
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $61.63 / $75.95 / $126.52	Professional	TC	$61.63	$75.95	$126.52
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.72 / $39.72 / $39.72	Facility	26	$39.72	$39.72	$39.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $84.61 / $132.04 / $226.09	Professional		$84.61	$132.04	$226.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.35 / $45.98 / $84.80	Professional	26	$30.35	$45.98	$84.80
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $138.68 / $138.68 / $138.68	Professional	50	$138.68	$138.68	$138.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $54.54 / $85.37 / $150.25	Professional	TC	$54.54	$85.37	$150.25
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $82.13 / $157.44 / $157.44	Facility	26	$82.13	$157.44	$157.44
Medica Facility/Professional Professional Modifier Low / Median / High Price $98.13 / $123.16 / $667.61	Professional		$98.13	$123.16	$667.61
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $34.43 / $43.35 / $219.03	Professional	26	$34.43	$43.35	$219.03
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $64.64 / $80.01 / $448.58	Professional	TC	$64.64	$80.01	$448.58
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $149.50 / $149.50 / $149.50	Professional		$149.50	$149.50	$149.50
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $94.89 / $94.89 / $94.89	Professional	26	$94.89	$94.89	$94.89
Qualchoice Facility/Professional Professional Modifier 50 Low / Median / High Price $262.25 / $262.25 / $262.25	Professional	50	$262.25	$262.25	$262.25
United Facility/Professional Professional Modifier Low / Median / High Price $94.40 / $118.16 / $196.20	Professional		$94.40	$118.16	$196.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.04 / $40.89 / $77.59	Professional	26	$33.04	$40.89	$77.59
United Facility/Professional Professional Modifier TC Low / Median / High Price $61.36 / $77.50 / $127.21	Professional	TC	$61.36	$77.50	$127.21