Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $67.61 / $295.12 / $457.09	Facility		$67.61	$295.12	$457.09
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.31 / $7.76 / $10.72	Facility	26	$6.31	$7.76	$10.72
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $16.98 / $25.70 / $363.08	Facility	TC	$16.98	$25.70	$363.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $16.22 / $33.88 / $107.15	Professional		$16.22	$33.88	$107.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.03 / $14.45 / $40.74	Professional	26	$6.03	$14.45	$40.74
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $22.39 / $81.28 / $281.84	Professional	50	$22.39	$81.28	$281.84
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $12.88 / $24.55 / $50.12	Professional	52	$12.88	$24.55	$50.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $22.91 / $64.57	Professional	TC	$15.85	$22.91	$64.57
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $17.38 / $21.88 / $41.69	Professional		$17.38	$21.88	$41.69
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.89 / $7.41 / $11.22	Professional	26	$5.89	$7.41	$11.22
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $25.70 / $36.31 / $44.67	Professional	50	$25.70	$36.31	$44.67
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $14.45 / $18.62 / $30.20	Professional	TC	$14.45	$18.62	$30.20
BCBS Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $125.89 / $251.19	Facility		$66.07	$125.89	$251.19
BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $44.67 / $58.88 / $426.58	Facility	TC	$44.67	$58.88	$426.58
BCBS Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $32.36 / $54.95	Professional		$28.18	$32.36	$54.95
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $13.49 / $22.91	Professional	26	$7.76	$13.49	$22.91
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $20.89 / $29.51	Professional	TC	$15.14	$20.89	$29.51
Cigna Facility/Professional Facility Modifier Low / Median / High Price $20.42 / $162.18 / $446.68	Facility		$20.42	$162.18	$446.68
Cigna Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $33.11 / $50.12	Professional		$24.55	$33.11	$50.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.24 / $9.77 / $15.49	Professional	26	$7.24	$9.77	$15.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $22.91 / $35.48	Professional	TC	$16.98	$22.91	$35.48
Medcost Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $53.70 / $53.70	Professional		$53.70	$53.70	$53.70
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $15.14 / $15.14	Professional	26	$15.14	$15.14	$15.14
Medcost Facility/Professional Facility Modifier Low / Median / High Price $23.44 / $36.31 / $63.10	Facility		$23.44	$36.31	$63.10
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $32.36 / $33.11	Professional		$32.36	$32.36	$33.11
United Facility/Professional Facility Modifier Low / Median / High Price $81.28 / $363.08 / $562.34	Facility		$81.28	$363.08	$562.34
United Facility/Professional Professional Modifier Low / Median / High Price $22.39 / $30.20 / $52.48	Professional		$22.39	$30.20	$52.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $8.91 / $15.49	Professional	26	$7.08	$8.91	$15.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $15.49 / $21.38 / $38.02	Professional	TC	$15.49	$21.38	$38.02