Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $97.83 / $764.40 / $1,403.18	Facility		$97.83	$764.40	$1,403.18
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.53 / $40.34 / $57.31	Facility	26	$32.53	$40.34	$57.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $95.93 / $136.33 / $461.21	Professional		$95.93	$136.33	$461.21
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.54 / $39.79 / $200.86	Professional	26	$32.54	$39.79	$200.86
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $63.40 / $87.95 / $150.37	Professional	TC	$63.40	$87.95	$150.37
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $83.42 / $112.10 / $182.49	Professional		$83.42	$112.10	$182.49
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.60 / $41.33 / $64.12	Professional	26	$28.60	$41.33	$64.12
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $56.73 / $68.45 / $95.83	Professional	TC	$56.73	$68.45	$95.83
BCBS Facility/Professional Facility Modifier Low / Median / High Price $195.12 / $353.47 / $617.79	Facility		$195.12	$353.47	$617.79
BCBS Facility/Professional Professional Modifier Low / Median / High Price $104.28 / $143.94 / $249.68	Professional		$104.28	$143.94	$249.68
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $35.82 / $72.00 / $104.23	Professional	26	$35.82	$72.00	$104.23
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $68.45 / $80.36 / $149.76	Professional	TC	$68.45	$80.36	$149.76
Cigna Facility/Professional Facility Modifier Low / Median / High Price $269.52 / $429.82 / $534.71	Facility		$269.52	$429.82	$534.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.70 / $148.00 / $255.31	Professional		$114.70	$148.00	$255.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.92 / $51.06 / $79.64	Professional	26	$36.92	$51.06	$79.64
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $75.30 / $101.05 / $174.18	Professional	TC	$75.30	$101.05	$174.18
Medcost Facility/Professional Facility Modifier Low / Median / High Price $104.34 / $183.87 / $276.89	Facility		$104.34	$183.87	$276.89
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $57.69 / $68.00 / $107.00	Facility	26	$57.69	$68.00	$107.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $88.83 / $88.83 / $423.90	Professional		$88.83	$88.83	$423.90
Medcost Facility/Professional Professional Modifier TC Low / Median / High Price $282.33 / $282.33 / $282.33	Professional	TC	$282.33	$282.33	$282.33
Molina Facility/Professional Professional Modifier Low / Median / High Price $44.14 / $98.86 / $180.58	Professional		$44.14	$98.86	$180.58
United Facility/Professional Professional Modifier Low / Median / High Price $104.72 / $133.31 / $232.18	Professional		$104.72	$133.31	$232.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.33 / $44.47 / $78.68	Professional	26	$34.33	$44.47	$78.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $70.86 / $90.61 / $154.57	Professional	TC	$70.86	$90.61	$154.57