Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $84.71 / $329.87 / $653.79	Facility		$84.71	$329.87	$653.79
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.54 / $6.55 / $11.79	Facility	26	$6.54	$6.55	$11.79
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $19.23 / $55.35 / $779.74	Facility	TC	$19.23	$55.35	$779.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $15.09 / $33.51 / $112.00	Professional		$15.09	$33.51	$112.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.55 / $9.76 / $45.90	Professional	26	$6.55	$9.76	$45.90
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $14.07 / $91.01 / $350.00	Professional	50	$14.07	$91.01	$350.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.57 / $20.92 / $41.33	Professional	TC	$17.57	$20.92	$41.33
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $23.45 / $30.57 / $50.91	Professional		$23.45	$30.57	$50.91
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.77 / $7.75 / $12.91	Professional	26	$5.77	$7.75	$12.91
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $45.86 / $45.86 / $64.91	Professional	50	$45.86	$45.86	$64.91
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $17.60 / $22.82 / $29.72	Professional	TC	$17.60	$22.82	$29.72
BCBS Facility/Professional Facility Modifier Low / Median / High Price $67.31 / $141.75 / $273.10	Facility		$67.31	$141.75	$273.10
BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $49.98 / $66.64 / $408.90	Facility	TC	$49.98	$66.64	$408.90
BCBS Facility/Professional Professional Modifier Low / Median / High Price $28.44 / $36.40 / $61.61	Professional		$28.44	$36.40	$61.61
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.21 / $19.00 / $26.07	Professional	26	$7.21	$19.00	$26.07
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $16.00 / $21.58 / $37.00	Professional	TC	$16.00	$21.58	$37.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $109.35 / $271.91 / $442.75	Facility		$109.35	$271.91	$442.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.51 / $36.00 / $64.09	Professional		$26.51	$36.00	$64.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.93 / $10.96 / $19.17	Professional	26	$7.93	$10.96	$19.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.00 / $24.86 / $46.17	Professional	TC	$18.00	$24.86	$46.17
Medcost Facility/Professional Facility Modifier Low / Median / High Price $28.55 / $45.00 / $74.37	Facility		$28.55	$45.00	$74.37
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $12.29 / $15.00 / $24.34	Facility	26	$12.29	$15.00	$24.34
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $26.83 / $40.00 / $64.95	Facility	TC	$26.83	$40.00	$64.95
Medcost Facility/Professional Professional Modifier Low / Median / High Price $112.28 / $112.28 / $112.28	Professional		$112.28	$112.28	$112.28
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $28.52 / $28.52 / $28.52	Professional	26	$28.52	$28.52	$28.52
Medcost Facility/Professional Professional Modifier 50 Low / Median / High Price $168.42 / $168.42 / $168.42	Professional	50	$168.42	$168.42	$168.42
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 $23.83 / $35.60 / $58.22	Professional		$23.83	$35.60	$58.22
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.47 / $9.94 / $16.11	Professional	26	$7.47	$9.94	$16.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.13 / $25.08 / $42.57	Professional	TC	$16.13	$25.08	$42.57