Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $112.18 / $112.18 / $112.18	Facility		$112.18	$112.18	$112.18
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $205.77 / $205.77 / $205.77	Facility	TC	$205.77	$205.77	$205.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $85.95 / $126.59 / $460.81	Professional		$85.95	$126.59	$460.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.93 / $40.15 / $176.30	Professional	26	$21.93	$40.15	$176.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $66.68 / $83.35 / $161.78	Professional	TC	$66.68	$83.35	$161.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $47.83 / $52.02 / $113.62	Professional		$47.83	$52.02	$113.62
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $11.06 / $15.58 / $40.47	Professional	26	$11.06	$15.58	$40.47
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $39.74 / $39.74 / $39.74	Professional	TC	$39.74	$39.74	$39.74
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $39.74 / $127.14 / $191.51	Professional		$39.74	$127.14	$191.51
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.23 / $40.11 / $53.72	Professional	26	$11.23	$40.11	$53.72
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $28.51 / $89.62 / $137.78	Professional	TC	$28.51	$89.62	$137.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $44.14 / $57.26 / $190.11	Professional		$44.14	$57.26	$190.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.58 / $25.28 / $72.87	Professional	26	$12.58	$25.28	$72.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.85 / $43.84 / $121.18	Professional	TC	$28.85	$43.84	$121.18
Medica Facility/Professional Facility Modifier Low / Median / High Price $71.86 / $107.61 / $246.85	Facility		$71.86	$107.61	$246.85
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $116.58 / $116.58 / $116.58	Facility	26	$116.58	$116.58	$116.58
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $390.55 / $390.55 / $390.55	Facility	TC	$390.55	$390.55	$390.55
Medica Facility/Professional Professional Modifier Low / Median / High Price $64.31 / $135.69 / $715.47	Professional		$64.31	$135.69	$715.47
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $16.67 / $34.19 / $162.69	Professional	26	$16.67	$34.19	$162.69
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $47.64 / $102.48 / $552.78	Professional	TC	$47.64	$102.48	$552.78
United Facility/Professional Professional Modifier Low / Median / High Price $64.31 / $96.46 / $214.38	Professional		$64.31	$96.46	$214.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.97 / $27.52 / $54.41	Professional	26	$15.97	$27.52	$54.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $47.04 / $76.15 / $156.00	Professional	TC	$47.04	$76.15	$156.00