Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $56.23 / $251.19 / $489.78	Facility		$56.23	$251.19	$489.78
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.72 / $11.75 / $15.14	Facility	26	$10.72	$11.75	$15.14
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $33.11 / $48.98 / $467.74	Facility	TC	$33.11	$48.98	$467.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $8.71 / $37.15 / $131.83	Professional		$8.71	$37.15	$131.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $12.88 / $42.66	Professional	26	$7.08	$12.88	$42.66
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $52.48 / $158.49 / $316.23	Professional	50	$52.48	$158.49	$316.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $33.11 / $109.65	Professional	TC	$19.95	$33.11	$109.65
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $23.44 / $30.20	Professional		$19.95	$23.44	$30.20
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.61 / $6.61 / $6.76	Professional	26	$6.61	$6.61	$6.76
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $37.15 / $37.15 / $37.15	Professional	50	$37.15	$37.15	$37.15
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $19.05 / $27.54	Professional	TC	$18.62	$19.05	$27.54
BCBS Facility/Professional Facility Modifier Low / Median / High Price $204.17 / $512.86 / $851.14	Facility		$204.17	$512.86	$851.14
BCBS Facility/Professional Professional Modifier Low / Median / High Price $6.03 / $25.12 / $42.66	Professional		$6.03	$25.12	$42.66
Cigna Facility/Professional Facility Modifier Low / Median / High Price $26.30 / $26.30 / $26.30	Facility		$26.30	$26.30	$26.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $40.74 / $63.10	Professional		$30.90	$40.74	$63.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $10.72 / $15.85	Professional	26	$7.08	$10.72	$15.85
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $29.51 / $47.86	Professional	TC	$22.91	$29.51	$47.86
Molina Facility/Professional Professional Modifier Low / Median / High Price $14.79 / $32.36 / $41.69	Professional		$14.79	$32.36	$41.69
Providence Facility/Professional Facility Modifier Low / Median / High Price $30.90 / $46.77 / $75.86	Facility		$30.90	$46.77	$75.86
Providence Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $51.29 / $81.28	Professional		$31.62	$51.29	$81.28
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $10.96 / $15.85	Professional	26	$7.41	$10.96	$15.85
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $32.36 / $44.67	Professional	TC	$22.91	$32.36	$44.67
United Facility/Professional Facility Modifier Low / Median / High Price $169.82 / $380.19 / $380.19	Facility		$169.82	$380.19	$380.19
United Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $35.48 / $64.57	Professional		$30.20	$35.48	$64.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $9.12 / $17.38	Professional	26	$8.32	$9.12	$17.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $26.30 / $50.12	Professional	TC	$21.88	$26.30	$50.12