Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.67 / $43.65 / $81.28	Facility	26	$34.67	$43.65	$81.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $199.53 / $562.34	Professional		$107.15	$199.53	$562.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $56.23 / $131.83	Professional	26	$33.11	$56.23	$131.83
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $32.36 / $57.54 / $537.03	Professional	52	$32.36	$57.54	$537.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $102.33 / $269.15	Professional	TC	$77.62	$102.33	$269.15
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $100.00 / $123.03	Professional		$91.20	$100.00	$123.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $38.90 / $56.23	Professional	26	$26.92	$38.90	$56.23
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $22.91 / $22.91 / $213.80	Professional	52	$22.91	$22.91	$213.80
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $79.43 / $109.65	Professional	TC	$64.57	$79.43	$109.65
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $134.90 / $239.88	Professional		$107.15	$134.90	$239.88
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $44.67 / $69.18	Professional	26	$37.15	$44.67	$69.18
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $95.50 / $169.82	Professional	TC	$58.88	$95.50	$169.82
BCBS Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $147.91 / $199.53	Professional		$131.83	$147.91	$199.53
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $38.90 / $60.26	Professional	26	$38.02	$38.90	$60.26
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $97.72 / $141.25	Professional	TC	$95.50	$97.72	$141.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $169.82 / $316.23	Professional		$107.15	$169.82	$316.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $48.98 / $91.20	Professional	26	$31.62	$48.98	$91.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $120.23 / $234.42	Professional	TC	$77.62	$120.23	$234.42
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $162.18 / $162.18	Facility	26	$85.11	$162.18	$162.18
Medica Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $169.82 / $831.76	Professional		$117.49	$169.82	$831.76
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $50.12 / $229.09	Professional	26	$38.90	$50.12	$229.09
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $123.03 / $602.56	Professional	TC	$85.11	$123.03	$602.56
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $186.21 / $218.78	Professional		$181.97	$186.21	$218.78
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $60.26 / $60.26	Professional	26	$60.26	$60.26	$60.26
Qualchoice Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $158.49 / $158.49	Professional	TC	$158.49	$158.49	$158.49
United Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $154.88 / $251.19	Professional		$123.03	$154.88	$251.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $44.67 / $70.79	Professional	26	$35.48	$44.67	$70.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $109.65 / $177.83	Professional	TC	$87.10	$109.65	$177.83