Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $148.40 / $531.40 / $625.00	Facility		$148.40	$531.40	$625.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $77.23 / $110.32 / $141.97	Facility	26	$77.23	$110.32	$141.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $136.78 / $206.37 / $338.55	Professional		$136.78	$206.37	$338.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.58 / $53.62 / $213.35	Professional	26	$37.58	$53.62	$213.35
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $95.45 / $143.80 / $189.16	Professional	TC	$95.45	$143.80	$189.16
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $85.34 / $115.81 / $170.67	Professional		$85.34	$115.81	$170.67
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $33.15 / $36.84 / $51.58	Professional	26	$33.15	$36.84	$51.58
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $30.48 / $42.67 / $42.67	Professional	52	$30.48	$42.67	$42.67
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $97.83 / $97.83 / $101.10	Professional	TC	$97.83	$97.83	$101.10
BCBS Facility/Professional Facility Modifier Low / Median / High Price $113.86 / $447.88 / $744.90	Facility		$113.86	$447.88	$744.90
BCBS Facility/Professional Professional Modifier Low / Median / High Price $96.74 / $128.99 / $161.24	Professional		$96.74	$128.99	$161.24
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $28.94 / $38.59 / $48.24	Professional	26	$28.94	$38.59	$48.24
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $67.80 / $90.40 / $113.00	Professional	TC	$67.80	$90.40	$113.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $250.00 / $250.00 / $643.95	Facility		$250.00	$250.00	$643.95
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.86 / $44.86 / $44.86	Facility	26	$44.86	$44.86	$44.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $146.06 / $237.25 / $408.88	Professional		$146.06	$237.25	$408.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.75 / $67.66 / $108.68	Professional	26	$39.75	$67.66	$108.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $106.31 / $177.07 / $299.50	Professional	TC	$106.31	$177.07	$299.50
Medica Facility/Professional Facility Modifier Low / Median / High Price $121.91 / $146.29 / $332.54	Facility		$121.91	$146.29	$332.54
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $91.76 / $174.10 / $174.10	Facility	26	$91.76	$174.10	$174.10
Medica Facility/Professional Professional Modifier Low / Median / High Price $149.76 / $223.85 / $1,023.12	Professional		$149.76	$223.85	$1,023.12
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $40.11 / $63.27 / $261.30	Professional	26	$40.11	$63.27	$261.30
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $107.10 / $160.58 / $767.60	Professional	TC	$107.10	$160.58	$767.60
United Facility/Professional Professional Modifier Low / Median / High Price $145.08 / $205.70 / $361.57	Professional		$145.08	$205.70	$361.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.76 / $58.14 / $97.47	Professional	26	$37.76	$58.14	$97.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $104.00 / $151.90 / $290.77	Professional	TC	$104.00	$151.90	$290.77