Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.04 / $39.33 / $60.38	Facility	26	$32.04	$39.33	$60.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $104.48 / $168.00 / $463.60	Professional		$104.48	$168.00	$463.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $50.43 / $134.16	Professional	26	$29.51	$50.43	$134.16
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $50.84 / $58.78 / $273.00	Professional	52	$50.84	$58.78	$273.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $75.31 / $94.76 / $345.00	Professional	TC	$75.31	$94.76	$345.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $81.13 / $100.72 / $164.21	Professional		$81.13	$100.72	$164.21
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $24.37 / $31.75 / $51.99	Professional	26	$24.37	$31.75	$51.99
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $21.90 / $21.90 / $21.90	Professional	52	$21.90	$21.90	$21.90
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $65.25 / $117.43 / $135.25	Professional	TC	$65.25	$117.43	$135.25
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $110.63 / $136.22 / $224.69	Professional		$110.63	$136.22	$224.69
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $34.38 / $42.30 / $68.13	Professional	26	$34.38	$42.30	$68.13
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $76.25 / $93.79 / $159.91	Professional	TC	$76.25	$93.79	$159.91
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.42 / $37.42 / $37.42	Facility	26	$37.42	$37.42	$37.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $91.72 / $135.77 / $263.06	Professional		$91.72	$135.77	$263.06
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.11 / $43.70 / $80.09	Professional	26	$28.11	$43.70	$80.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $62.05 / $97.78 / $190.92	Professional	TC	$62.05	$97.78	$190.92
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $77.65 / $148.36 / $148.36	Facility	26	$77.65	$148.36	$148.36
Medica Facility/Professional Professional Modifier Low / Median / High Price $109.36 / $149.44 / $778.42	Professional		$109.36	$149.44	$778.42
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $33.60 / $43.35 / $290.60	Professional	26	$33.60	$43.35	$290.60
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $76.72 / $104.38 / $570.15	Professional	TC	$76.72	$104.38	$570.15
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $200.48 / $200.48 / $200.48	Professional		$200.48	$200.48	$200.48
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $51.65 / $51.65 / $59.79	Professional	26	$51.65	$51.65	$59.79
United Facility/Professional Professional Modifier Low / Median / High Price $103.53 / $134.82 / $248.36	Professional		$103.53	$134.82	$248.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.83 / $38.75 / $67.20	Professional	26	$31.83	$38.75	$67.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $76.38 / $94.35 / $157.38	Professional	TC	$76.38	$94.35	$157.38