Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $81.01 / $313.94 / $627.88	Facility		$81.01	$313.94	$627.88
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.11 / $9.11 / $16.05	Facility	26	$9.11	$9.11	$16.05
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $29.12 / $292.91 / $592.14	Facility	TC	$29.12	$292.91	$592.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $15.54 / $43.31 / $145.86	Professional		$15.54	$43.31	$145.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.11 / $10.81 / $41.50	Professional	26	$9.11	$10.81	$41.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.55 / $31.95 / $70.31	Professional	TC	$27.55	$31.95	$70.31
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $36.36 / $61.83 / $76.59	Professional		$36.36	$61.83	$76.59
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.02 / $10.79 / $17.97	Professional	26	$8.02	$10.79	$17.97
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $27.14 / $45.85 / $58.62	Professional	TC	$27.14	$45.85	$58.62
BCBS Facility/Professional Facility Modifier Low / Median / High Price $81.08 / $166.91 / $265.54	Facility		$81.08	$166.91	$265.54
BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $84.15 / $112.20 / $112.20	Facility	TC	$84.15	$112.20	$112.20
BCBS Facility/Professional Professional Modifier Low / Median / High Price $42.79 / $84.00 / $148.82	Professional		$42.79	$84.00	$148.82
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.03 / $42.00 / $66.22	Professional	26	$10.03	$42.00	$66.22
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $32.75 / $36.61 / $88.00	Professional	TC	$32.75	$36.61	$88.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $172.44 / $274.29 / $442.75	Facility		$172.44	$274.29	$442.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $39.28 / $49.96 / $94.74	Professional		$39.28	$49.96	$94.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.44 / $14.32 / $25.00	Professional	26	$11.44	$14.32	$25.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.73 / $38.11 / $69.73	Professional	TC	$28.73	$38.11	$69.73
Medcost Facility/Professional Facility Modifier Low / Median / High Price $41.46 / $57.64 / $107.42	Facility		$41.46	$57.64	$107.42
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $16.73 / $18.34 / $33.45	Facility	26	$16.73	$18.34	$33.45
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $41.04 / $41.04 / $93.87	Facility	TC	$41.04	$41.04	$93.87
Medcost Facility/Professional Professional Modifier Low / Median / High Price $167.18 / $167.18 / $167.18	Professional		$167.18	$167.18	$167.18
Medcost Facility/Professional Professional Modifier 50 Low / Median / High Price $250.77 / $250.77 / $250.77	Professional	50	$250.77	$250.77	$250.77
Medcost Facility/Professional Professional Modifier TC Low / Median / High Price $127.51 / $127.51 / $127.51	Professional	TC	$127.51	$127.51	$127.51
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 $36.79 / $50.81 / $87.36	Professional		$36.79	$50.81	$87.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.55 / $13.48 / $21.95	Professional	26	$10.55	$13.48	$21.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.19 / $38.44 / $64.31	Professional	TC	$26.19	$38.44	$64.31