Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.00 / $14.16 / $28.85	Facility	26	$12.00	$14.16	$28.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $76.75 / $115.56 / $375.32	Professional		$76.75	$115.56	$375.32
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.21 / $14.80 / $44.10	Professional	26	$11.21	$14.80	$44.10
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $38.25 / $43.19 / $292.64	Professional	52	$38.25	$43.19	$292.64
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $60.88 / $84.36 / $180.24	Professional	TC	$60.88	$84.36	$180.24
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $55.52 / $77.27 / $92.79	Professional		$55.52	$77.27	$92.79
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.52 / $13.18 / $16.76	Professional	26	$8.52	$13.18	$16.76
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $23.20 / $23.20 / $23.20	Professional	52	$23.20	$23.20	$23.20
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $85.00 / $113.15 / $177.85	Professional		$85.00	$113.15	$177.85
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.51 / $16.00 / $26.54	Professional	26	$12.51	$16.00	$26.54
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $68.87 / $99.10 / $162.43	Professional	TC	$68.87	$99.10	$162.43
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.54 / $13.54 / $13.54	Facility	26	$13.54	$13.54	$13.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $75.29 / $123.40 / $218.11	Professional		$75.29	$123.40	$218.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.82 / $17.17 / $31.74	Professional	26	$11.82	$17.17	$31.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $67.20 / $107.30 / $197.76	Professional	TC	$67.20	$107.30	$197.76
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $27.12 / $125.86 / $125.86	Facility	26	$27.12	$125.86	$125.86
Medica Facility/Professional Professional Modifier Low / Median / High Price $86.62 / $125.50 / $768.54	Professional		$86.62	$125.50	$768.54
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $11.69 / $18.26 / $267.48	Professional	26	$11.69	$18.26	$267.48
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $73.63 / $111.11 / $698.48	Professional	TC	$73.63	$111.11	$698.48
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $16.35 / $16.35 / $16.35	Professional	26	$16.35	$16.35	$16.35
Qualchoice Facility/Professional Professional Modifier 52 Low / Median / High Price $26.68 / $26.68 / $26.68	Professional	52	$26.68	$26.68	$26.68
United Facility/Professional Professional Modifier Low / Median / High Price $84.14 / $106.43 / $202.36	Professional		$84.14	$106.43	$202.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.35 / $16.05 / $27.49	Professional	26	$11.35	$16.05	$27.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $73.52 / $92.04 / $156.72	Professional	TC	$73.52	$92.04	$156.72