Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $98.89 / $313.12 / $662.70	Facility		$98.89	$313.12	$662.70
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.26 / $48.55 / $852.30	Facility	26	$26.26	$48.55	$852.30
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $87.23 / $296.95 / $1,379.20	Facility	TC	$87.23	$296.95	$1,379.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.44 / $133.18 / $622.51	Professional		$81.44	$133.18	$622.51
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.06 / $44.46 / $157.63	Professional	26	$29.06	$44.46	$157.63
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $40.72 / $65.84 / $328.05	Professional	52	$40.72	$65.84	$328.05
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.06 / $89.16 / $208.07	Professional	TC	$61.06	$89.16	$208.07
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $105.03 / $105.03 / $105.03	Professional		$105.03	$105.03	$105.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.68 / $30.68 / $33.11	Professional	26	$30.68	$30.68	$33.11
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $51.15 / $51.15 / $51.15	Professional	TC	$51.15	$51.15	$51.15
BCBS Facility/Professional Facility Modifier Low / Median / High Price $145.94 / $508.46 / $871.96	Facility		$145.94	$508.46	$871.96
BCBS Facility/Professional Professional Modifier Low / Median / High Price $25.10 / $74.41 / $133.94	Professional		$25.10	$74.41	$133.94
Cigna Facility/Professional Facility Modifier Low / Median / High Price $69.23 / $69.23 / $69.23	Facility		$69.23	$69.23	$69.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $97.58 / $154.33 / $218.63	Professional		$97.58	$154.33	$218.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.81 / $45.87 / $63.51	Professional	26	$30.81	$45.87	$63.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $64.48 / $109.37 / $157.05	Professional	TC	$64.48	$109.37	$157.05
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $49.83 / $135.78	Professional		$32.34	$49.83	$135.78
Providence Facility/Professional Facility Modifier Low / Median / High Price $97.58 / $150.63 / $192.97	Facility		$97.58	$150.63	$192.97
Providence Facility/Professional Professional Modifier Low / Median / High Price $102.41 / $192.91 / $262.58	Professional		$102.41	$192.91	$262.58
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $31.15 / $48.91 / $63.51	Professional	26	$31.15	$48.91	$63.51
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $64.48 / $110.86 / $157.05	Professional	TC	$64.48	$110.86	$157.05
United Facility/Professional Facility Modifier Low / Median / High Price $235.69 / $235.69 / $235.69	Facility		$235.69	$235.69	$235.69
United Facility/Professional Professional Modifier Low / Median / High Price $115.13 / $134.21 / $226.50	Professional		$115.13	$134.21	$226.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.70 / $37.68 / $73.84	Professional	26	$36.70	$37.68	$73.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.59 / $97.51 / $152.66	Professional	TC	$77.59	$97.51	$152.66