Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $120.23 / $154.88 / $1,000.00	Facility	26	$120.23	$154.88	$1,000.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $812.83 / $2,454.71	Professional		$588.84	$812.83	$2,454.71
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $186.21 / $549.54	Professional	26	$114.82	$186.21	$549.54
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $181.97 / $229.09 / $645.65	Professional	52	$181.97	$229.09	$645.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $467.74 / $630.96 / $1,479.11	Professional	TC	$467.74	$630.96	$1,479.11
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $588.84 / $870.96	Professional		$537.03	$588.84	$870.96
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $144.54 / $190.55	Professional	26	$112.20	$144.54	$190.55
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $467.74 / $467.74 / $489.78	Professional	TC	$467.74	$467.74	$489.78
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $602.56 / $741.31 / $1,174.90	Professional		$602.56	$741.31	$1,174.90
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $151.36 / $309.03	Professional	26	$120.23	$151.36	$309.03
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $467.74 / $602.56 / $954.99	Professional	TC	$467.74	$602.56	$954.99
BCBS Facility/Professional Professional Modifier Low / Median / High Price $691.83 / $812.83 / $1,174.90	Professional		$691.83	$812.83	$1,174.90
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $151.36 / $218.78	Professional	26	$128.82	$151.36	$218.78
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $549.54 / $660.69 / $954.99	Professional	TC	$549.54	$660.69	$954.99
Cigna Facility/Professional Professional Modifier Low / Median / High Price $645.65 / $912.01 / $1,348.96	Professional		$645.65	$912.01	$1,348.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $186.21 / $281.84	Professional	26	$128.82	$186.21	$281.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $512.86 / $724.44 / $1,096.48	Professional	TC	$512.86	$724.44	$1,096.48
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $288.40 / $758.58 / $758.58	Facility	26	$288.40	$758.58	$758.58
Medica Facility/Professional Professional Modifier Low / Median / High Price $602.56 / $954.99 / $6,165.95	Professional		$602.56	$954.99	$6,165.95
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $204.17 / $1,071.52	Professional	26	$120.23	$204.17	$1,071.52
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $478.63 / $776.25 / $3,890.45	Professional	TC	$478.63	$776.25	$3,890.45
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $173.78 / $173.78 / $173.78	Professional	26	$173.78	$173.78	$173.78
United Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $758.58 / $1,258.93	Professional		$588.84	$758.58	$1,258.93
United Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $154.88 / $269.15	Professional	26	$117.49	$154.88	$269.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $467.74 / $616.60 / $1,000.00	Professional	TC	$467.74	$616.60	$1,000.00