Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $95.69 / $267.36 / $489.98	Facility		$95.69	$267.36	$489.98
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 $18.69 / $25.34 / $374.08	Facility	TC	$18.69	$25.34	$374.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $18.12 / $29.73 / $81.56	Professional		$18.12	$29.73	$81.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.81 / $8.26 / $37.40	Professional	26	$6.81	$8.26	$37.40
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $16.45 / $64.90 / $304.00	Professional	50	$16.45	$64.90	$304.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $10.10 / $12.76 / $15.74	Professional	52	$10.10	$12.76	$15.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.89 / $19.91 / $45.12	Professional	TC	$17.89	$19.91	$45.12
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $28.15 / $30.26 / $50.39	Professional		$28.15	$30.26	$50.39
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.01 / $8.64 / $13.44	Professional	26	$6.01	$8.64	$13.44
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $42.23 / $45.39 / $45.39	Professional	50	$42.23	$45.39	$45.39
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $24.45 / $28.90 / $47.11	Professional	TC	$24.45	$28.90	$47.11
BCBS Facility/Professional Facility Modifier Low / Median / High Price $75.79 / $154.21 / $263.97	Facility		$75.79	$154.21	$263.97
BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $48.44 / $64.58 / $408.90	Facility	TC	$48.44	$64.58	$408.90
BCBS Facility/Professional Professional Modifier Low / Median / High Price $28.15 / $34.08 / $56.70	Professional		$28.15	$34.08	$56.70
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.51 / $15.00 / $25.26	Professional	26	$7.51	$15.00	$25.26
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $17.00 / $21.67 / $34.70	Professional	TC	$17.00	$21.67	$34.70
Cigna Facility/Professional Facility Modifier Low / Median / High Price $106.30 / $319.88 / $534.71	Facility		$106.30	$319.88	$534.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $25.25 / $35.11 / $63.35	Professional		$25.25	$35.11	$63.35
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.67 / $10.81 / $18.64	Professional	26	$7.67	$10.81	$18.64
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.79 / $24.33 / $44.70	Professional	TC	$17.79	$24.33	$44.70
Medcost Facility/Professional Facility Modifier Low / Median / High Price $27.33 / $40.71 / $73.51	Facility		$27.33	$40.71	$73.51
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $11.27 / $14.00 / $23.33	Facility	26	$11.27	$14.00	$23.33
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $26.10 / $39.97 / $60.21	Facility	TC	$26.10	$39.97	$60.21
Medcost Facility/Professional Professional Modifier Low / Median / High Price $111.10 / $111.10 / $111.10	Professional		$111.10	$111.10	$111.10
Medcost Facility/Professional Professional Modifier 50 Low / Median / High Price $166.65 / $166.65 / $166.65	Professional	50	$166.65	$166.65	$166.65
Medcost Facility/Professional Professional Modifier TC Low / Median / High Price $81.40 / $81.40 / $81.40	Professional	TC	$81.40	$81.40	$81.40
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 Facility Modifier Low / Median / High Price $108.97 / $108.97 / $123.98	Facility		$108.97	$108.97	$123.98
United Facility/Professional Professional Modifier Low / Median / High Price $22.94 / $32.74 / $57.36	Professional		$22.94	$32.74	$57.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.27 / $10.36 / $16.45	Professional	26	$7.27	$10.36	$16.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $15.93 / $22.86 / $41.22	Professional	TC	$15.93	$22.86	$41.22