Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $57.54 / $169.82 / $263.03	Facility		$57.54	$169.82	$263.03
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.88 / $33.88 / $100.00	Facility	26	$33.88	$33.88	$100.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $85.11 / $229.09	Professional		$42.66	$85.11	$229.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $50.12 / $107.15	Professional	26	$34.67	$50.12	$107.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $37.15 / $147.91	Professional	TC	$25.70	$37.15	$147.91
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $23.44 / $35.48 / $67.61	Professional		$23.44	$35.48	$67.61
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $41.69 / $74.13	Professional	26	$39.81	$41.69	$74.13
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $12.02 / $15.14 / $22.91	Professional	TC	$12.02	$15.14	$22.91
BCBS Facility/Professional Facility Modifier Low / Median / High Price $38.02 / $38.02 / $38.02	Facility		$38.02	$38.02	$38.02
BCBS Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $346.74 / $346.74	Professional		$346.74	$346.74	$346.74
Cigna Facility/Professional Facility Modifier Low / Median / High Price $27.54 / $27.54 / $194.98	Facility		$27.54	$27.54	$194.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $138.04 / $416.87	Professional		$63.10	$138.04	$416.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $83.18 / $169.82	Professional	26	$38.02	$83.18	$169.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $60.26 / $257.04	Professional	TC	$26.30	$60.26	$257.04
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $32.36 / $33.11	Professional		$32.36	$32.36	$33.11
United Facility/Professional Facility Modifier Low / Median / High Price $218.78 / $537.03 / $1,621.81	Facility		$218.78	$537.03	$1,621.81
United Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $169.82 / $363.08	Professional		$61.66	$169.82	$363.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $83.18 / $154.88	Professional	26	$35.48	$83.18	$154.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $70.79 / $208.93	Professional	TC	$25.70	$70.79	$208.93