Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.67 / $56.23 / $79.43	Facility	26	$44.67	$56.23	$79.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $194.98 / $645.65	Professional		$87.10	$194.98	$645.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $77.62 / $263.03	Professional	26	$41.69	$77.62	$263.03
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $70.79 / $186.21 / $389.05	Professional	50	$70.79	$186.21	$389.05
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $53.70 / $100.00	Professional	TC	$39.81	$53.70	$100.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $100.00 / $141.25	Professional		$77.62	$100.00	$141.25
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $54.95 / $63.10	Professional	26	$38.90	$54.95	$63.10
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $69.18 / $69.18	Professional	TC	$69.18	$69.18	$69.18
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $93.33 / $158.49	Professional		$70.79	$93.33	$158.49
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $46.77 / $74.13	Professional	26	$38.90	$46.77	$74.13
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $44.67 / $81.28	Professional	TC	$30.90	$44.67	$81.28
BCBS Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $114.82 / $162.18	Professional		$97.72	$114.82	$162.18
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $54.95 / $79.43	Professional	26	$46.77	$54.95	$79.43
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $61.66 / $87.10	Professional	TC	$50.12	$61.66	$87.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $125.89 / $190.55	Professional		$91.20	$125.89	$190.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $63.10 / $97.72	Professional	26	$45.71	$63.10	$97.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $61.66 / $100.00	Professional	TC	$44.67	$61.66	$100.00
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $102.33 / $199.53 / $199.53	Facility	26	$102.33	$199.53	$199.53
Medica Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $125.89 / $645.65	Professional		$89.13	$125.89	$645.65
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $61.66 / $281.84	Professional	26	$43.65	$61.66	$281.84
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $61.66 / $354.81	Professional	TC	$40.74	$61.66	$354.81
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $125.89 / $138.04	Professional		$107.15	$125.89	$138.04
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $66.07 / $66.07	Professional	26	$66.07	$66.07	$66.07
United Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $109.65 / $177.83	Professional		$83.18	$109.65	$177.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $54.95 / $91.20	Professional	26	$42.66	$54.95	$91.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $54.95 / $91.20	Professional	TC	$39.81	$54.95	$91.20