Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $81.39 / $371.98 / $735.47	Facility		$81.39	$371.98	$735.47
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.66 / $7.67 / $13.51	Facility	26	$7.66	$7.67	$13.51
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $25.39 / $363.96 / $821.80	Facility	TC	$25.39	$363.96	$821.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $26.64 / $41.14 / $131.75	Professional		$26.64	$41.14	$131.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.67 / $12.09 / $49.30	Professional	26	$7.67	$12.09	$49.30
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $36.47 / $79.79 / $324.00	Professional	50	$36.47	$79.79	$324.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $13.32 / $16.53 / $18.96	Professional	52	$13.32	$16.53	$18.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.44 / $29.94 / $79.02	Professional	TC	$24.44	$29.94	$79.02
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $31.00 / $45.35 / $65.28	Professional		$31.00	$45.35	$65.28
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.75 / $8.94 / $15.13	Professional	26	$6.75	$8.94	$15.13
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $45.13 / $58.81 / $97.92	Professional	50	$45.13	$58.81	$97.92
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $23.23 / $30.12 / $63.95	Professional	TC	$23.23	$30.12	$63.95
BCBS Facility/Professional Facility Modifier Low / Median / High Price $74.17 / $153.33 / $263.97	Facility		$74.17	$153.33	$263.97
BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $55.35 / $73.80 / $408.90	Facility	TC	$55.35	$73.80	$408.90
BCBS Facility/Professional Professional Modifier Low / Median / High Price $36.47 / $42.64 / $79.45	Professional		$36.47	$42.64	$79.45
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $8.44 / $22.00 / $28.85	Professional	26	$8.44	$22.00	$28.85
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $16.00 / $28.02 / $44.00	Professional	TC	$16.00	$28.02	$44.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $144.33 / $271.91 / $442.75	Facility		$144.33	$271.91	$442.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.54 / $43.13 / $81.91	Professional		$30.54	$43.13	$81.91
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.63 / $12.43 / $21.01	Professional	26	$8.63	$12.43	$21.01
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.00 / $31.27 / $60.90	Professional	TC	$22.00	$31.27	$60.90
Medcost Facility/Professional Facility Modifier Low / Median / High Price $36.36 / $51.08 / $95.38	Facility		$36.36	$51.08	$95.38
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $13.41 / $16.00 / $27.88	Facility	26	$13.41	$16.00	$27.88
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $34.97 / $51.97 / $84.42	Facility	TC	$34.97	$51.97	$84.42
Medcost Facility/Professional Professional Modifier Low / Median / High Price $145.54 / $145.54 / $145.54	Professional		$145.54	$145.54	$145.54
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $33.40 / $33.40 / $33.40	Professional	26	$33.40	$33.40	$33.40
Medcost Facility/Professional Professional Modifier 50 Low / Median / High Price $218.32 / $218.32 / $218.32	Professional	50	$218.32	$218.32	$218.32
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 $28.96 / $42.24 / $75.43	Professional		$28.96	$42.24	$75.43
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.58 / $11.21 / $17.53	Professional	26	$8.58	$11.21	$17.53
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.08 / $30.43 / $56.15	Professional	TC	$21.08	$30.43	$56.15