Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.36 / $50.21 / $97.05	Facility	26	$45.36	$50.21	$97.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $133.59 / $166.95 / $887.00	Professional		$133.59	$166.95	$887.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.29 / $53.84 / $131.46	Professional	26	$41.29	$53.84	$131.46
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $91.98 / $120.78 / $296.19	Professional	TC	$91.98	$120.78	$296.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $89.48 / $125.72 / $230.48	Professional		$89.48	$125.72	$230.48
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $34.89 / $52.33 / $67.94	Professional	26	$34.89	$52.33	$67.94
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $93.16 / $93.16 / $93.16	Professional	TC	$93.16	$93.16	$93.16
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $143.00 / $172.10 / $318.80	Professional		$143.00	$172.10	$318.80
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $46.94 / $58.26 / $101.70	Professional	26	$46.94	$58.26	$101.70
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $88.50 / $121.89 / $216.32	Professional	TC	$88.50	$121.89	$216.32
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.02 / $54.02 / $54.02	Facility	26	$54.02	$54.02	$54.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $132.38 / $215.38 / $344.75	Professional		$132.38	$215.38	$344.75
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.22 / $66.48 / $103.85	Professional	26	$41.22	$66.48	$103.85
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $93.55 / $151.58 / $242.48	Professional	TC	$93.55	$151.58	$242.48
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $111.37 / $211.96 / $211.96	Facility	26	$111.37	$211.96	$211.96
Medica Facility/Professional Professional Modifier Low / Median / High Price $166.27 / $212.85 / $1,024.30	Professional		$166.27	$212.85	$1,024.30
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $50.67 / $64.01 / $300.10	Professional	26	$50.67	$64.01	$300.10
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $115.60 / $148.32 / $724.19	Professional	TC	$115.60	$148.32	$724.19
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $265.05 / $265.05 / $265.05	Professional		$265.05	$265.05	$265.05
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $78.13 / $78.13 / $78.13	Professional	26	$78.13	$78.13	$78.13
United Facility/Professional Professional Modifier Low / Median / High Price $166.27 / $199.52 / $326.39	Professional		$166.27	$199.52	$326.39
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.10 / $59.81 / $102.50	Professional	26	$50.10	$59.81	$102.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $115.60 / $138.72 / $233.32	Professional	TC	$115.60	$138.72	$233.32