Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $119.64 / $258.39 / $516.92	Facility		$119.64	$258.39	$516.92
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.80 / $6.81 / $12.01	Facility	26	$6.80	$6.81	$12.01
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $20.83 / $26.27 / $492.40	Facility	TC	$20.83	$26.27	$492.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $18.12 / $31.78 / $110.80	Professional		$18.12	$31.78	$110.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.81 / $9.07 / $39.10	Professional	26	$6.81	$9.07	$39.10
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $59.43 / $96.70 / $328.00	Professional	50	$59.43	$96.70	$328.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $11.01 / $13.83 / $17.11	Professional	52	$11.01	$13.83	$17.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.07 / $22.22 / $43.64	Professional	TC	$20.07	$22.22	$43.64
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $24.92 / $45.98 / $54.09	Professional		$24.92	$45.98	$54.09
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.01 / $7.51 / $13.44	Professional	26	$6.01	$7.51	$13.44
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $48.73 / $48.73 / $48.73	Professional	50	$48.73	$48.73	$48.73
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $18.82 / $18.82 / $27.02	Professional	TC	$18.82	$18.82	$27.02
BCBS Facility/Professional Facility Modifier Low / Median / High Price $63.09 / $150.51 / $263.97	Facility		$63.09	$150.51	$263.97
BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $47.68 / $63.57 / $408.90	Facility	TC	$47.68	$63.57	$408.90
BCBS Facility/Professional Professional Modifier Low / Median / High Price $30.22 / $35.71 / $59.67	Professional		$30.22	$35.71	$59.67
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.51 / $17.00 / $24.15	Professional	26	$7.51	$17.00	$24.15
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $16.00 / $22.71 / $34.07	Professional	TC	$16.00	$22.71	$34.07
Cigna Facility/Professional Facility Modifier Low / Median / High Price $116.95 / $271.91 / $442.75	Facility		$116.95	$271.91	$442.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $25.33 / $36.15 / $68.51	Professional		$25.33	$36.15	$68.51
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.67 / $10.88 / $18.64	Professional	26	$7.67	$10.88	$18.64
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.67 / $25.74 / $49.85	Professional	TC	$18.67	$25.74	$49.85
Medcost Facility/Professional Facility Modifier Low / Median / High Price $29.31 / $43.00 / $79.77	Facility		$29.31	$43.00	$79.77
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $11.87 / $15.00 / $24.34	Facility	26	$11.87	$15.00	$24.34
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $29.09 / $44.55 / $67.14	Facility	TC	$29.09	$44.55	$67.14
Medcost Facility/Professional Professional Modifier Low / Median / High Price $120.56 / $120.56 / $120.56	Professional		$120.56	$120.56	$120.56
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $29.70 / $29.70 / $29.70	Professional	26	$29.70	$29.70	$29.70
Medcost Facility/Professional Professional Modifier 50 Low / Median / High Price $180.84 / $180.84 / $180.84	Professional	50	$180.84	$180.84	$180.84
Molina Facility/Professional Professional Modifier Low / Median / High Price $25.48 / $34.77 / $51.41	Professional		$25.48	$34.77	$51.41
United Facility/Professional Professional Modifier Low / Median / High Price $24.20 / $36.54 / $62.80	Professional		$24.20	$36.54	$62.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.58 / $10.36 / $16.45	Professional	26	$7.58	$10.36	$16.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.41 / $26.43 / $44.17	Professional	TC	$17.41	$26.43	$44.17