Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $96.37 / $488.80 / $863.95	Facility		$96.37	$488.80	$863.95
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.67 / $36.79 / $52.27	Facility	26	$29.67	$36.79	$52.27
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $59.64 / $170.51 / $540.79	Facility	TC	$59.64	$170.51	$540.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.32 / $133.18 / $420.75	Professional		$89.32	$133.18	$420.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.67 / $41.75 / $183.60	Professional	26	$29.67	$41.75	$183.60
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $41.72 / $46.94 / $66.59	Professional	52	$41.72	$46.94	$66.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $59.65 / $87.95 / $146.84	Professional	TC	$59.65	$87.95	$146.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $80.02 / $104.59 / $170.26	Professional		$80.02	$104.59	$170.26
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $26.14 / $40.49 / $58.48	Professional	26	$26.14	$40.49	$58.48
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $53.55 / $76.89 / $90.45	Professional	TC	$53.55	$76.89	$90.45
BCBS Facility/Professional Facility Modifier Low / Median / High Price $177.79 / $334.17 / $611.89	Facility		$177.79	$334.17	$611.89
BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $132.08 / $176.10 / $886.09	Facility	TC	$132.08	$176.10	$886.09
BCBS Facility/Professional Professional Modifier Low / Median / High Price $97.29 / $139.00 / $244.40	Professional		$97.29	$139.00	$244.40
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $32.67 / $64.00 / $108.43	Professional	26	$32.67	$64.00	$108.43
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $64.61 / $80.76 / $133.40	Professional	TC	$64.61	$80.76	$133.40
Cigna Facility/Professional Facility Modifier Low / Median / High Price $269.52 / $363.65 / $534.71	Facility		$269.52	$363.65	$534.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $107.01 / $142.11 / $239.61	Professional		$107.01	$142.11	$239.61
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.79 / $46.56 / $72.68	Professional	26	$33.79	$46.56	$72.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.08 / $95.86 / $167.90	Professional	TC	$72.08	$95.86	$167.90
Medcost Facility/Professional Facility Modifier Low / Median / High Price $96.44 / $175.16 / $257.70	Facility		$96.44	$175.16	$257.70
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $52.53 / $63.00 / $97.33	Facility	26	$52.53	$63.00	$97.33
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $100.80 / $124.85 / $200.45	Facility	TC	$100.80	$124.85	$200.45
Medcost Facility/Professional Professional Modifier Low / Median / High Price $88.83 / $88.83 / $392.55	Professional		$88.83	$88.83	$392.55
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $129.13 / $129.13 / $129.13	Professional	26	$129.13	$129.13	$129.13
Molina Facility/Professional Professional Modifier Low / Median / High Price $44.14 / $83.61 / $137.35	Professional		$44.14	$83.61	$137.35
United Facility/Professional Facility Modifier Low / Median / High Price $108.97 / $108.97 / $123.98	Facility		$108.97	$108.97	$123.98
United Facility/Professional Professional Modifier Low / Median / High Price $97.86 / $127.79 / $220.91	Professional		$97.86	$127.79	$220.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.98 / $40.15 / $68.40	Professional	26	$30.98	$40.15	$68.40
United Facility/Professional Professional Modifier TC Low / Median / High Price $65.95 / $84.32 / $143.87	Professional	TC	$65.95	$84.32	$143.87