Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $204.00 / $204.00 / $612.00	Facility		$204.00	$204.00	$612.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $60.56 / $71.95 / $133.22	Professional		$60.56	$71.95	$133.22
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.37 / $36.53 / $88.26	Professional	26	$31.37	$36.53	$88.26
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $24.92 / $30.28 / $35.97	Professional	52	$24.92	$30.28	$35.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $29.19 / $49.03 / $95.49	Professional	TC	$29.19	$49.03	$95.49
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $32.53 / $32.53 / $65.05	Professional		$32.53	$32.53	$65.05
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $16.91 / $17.20 / $43.95	Professional	26	$16.91	$17.20	$43.95
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $31.24 / $31.24 / $31.24	Professional	TC	$31.24	$31.24	$31.24
BCBS Facility/Professional Professional Modifier Low / Median / High Price $69.55 / $112.92 / $112.92	Professional		$69.55	$112.92	$112.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.24 / $115.06 / $183.00	Professional		$35.24	$115.06	$183.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.23 / $49.20 / $87.00	Professional	26	$19.23	$49.20	$87.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.05 / $73.38 / $96.00	Professional	TC	$16.05	$73.38	$96.00
Medica Facility/Professional Facility Modifier Low / Median / High Price $60.56 / $89.92 / $159.88	Facility		$60.56	$89.92	$159.88
Medica Facility/Professional Professional Modifier Low / Median / High Price $69.65 / $100.04 / $547.54	Professional		$69.65	$100.04	$547.54
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $36.86 / $51.19 / $292.24	Professional	26	$36.86	$51.19	$292.24
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $30.22 / $63.40 / $349.50	Professional	TC	$30.22	$63.40	$349.50
United Facility/Professional Professional Modifier Low / Median / High Price $45.20 / $92.63 / $103.99	Professional		$45.20	$92.63	$103.99
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.61 / $39.34 / $55.08	Professional	26	$23.61	$39.34	$55.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.22 / $40.97 / $67.84	Professional	TC	$30.22	$40.97	$67.84