Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $53.70 / $53.70 / $158.49	Facility		$53.70	$53.70	$158.49
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.20 / $30.20 / $30.20	Facility	26	$30.20	$30.20	$30.20
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $23.44 / $23.44 / $371.54	Facility	TC	$23.44	$23.44	$371.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $69.18 / $114.82	Professional		$28.18	$69.18	$114.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $22.91 / $64.57	Professional	26	$15.14	$22.91	$64.57
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $77.62 / $234.42 / $338.84	Professional	50	$77.62	$234.42	$338.84
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $43.65 / $43.65 / $43.65	Professional	52	$43.65	$43.65	$43.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $12.02 / $19.05 / $64.57	Professional	TC	$12.02	$19.05	$64.57
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $33.11 / $38.90	Professional		$28.18	$33.11	$38.90
BCBS Facility/Professional Facility Modifier Low / Median / High Price $251.19 / $537.03 / $912.01	Facility		$251.19	$537.03	$912.01
BCBS Facility/Professional Professional Modifier Low / Median / High Price $19.05 / $29.51 / $67.61	Professional		$19.05	$29.51	$67.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $77.62 / $131.83	Professional		$37.15	$77.62	$131.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $28.84 / $38.90	Professional	26	$18.20	$28.84	$38.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.22 / $52.48 / $81.28	Professional	TC	$16.22	$52.48	$81.28
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $70.79	Professional		$32.36	$33.11	$70.79
Providence Facility/Professional Facility Modifier Low / Median / High Price $37.15 / $67.61 / $128.82	Facility		$37.15	$67.61	$128.82
Providence Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $83.18 / $120.23	Professional		$45.71	$83.18	$120.23
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $29.51 / $38.90	Professional	26	$18.20	$29.51	$38.90
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $54.95 / $83.18	Professional	TC	$19.05	$54.95	$83.18
United Facility/Professional Facility Modifier Low / Median / High Price $263.03 / $575.44 / $575.44	Facility		$263.03	$575.44	$575.44
United Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $89.13 / $125.89	Professional		$45.71	$89.13	$125.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $33.88 / $42.66	Professional	26	$21.88	$33.88	$42.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $57.54 / $87.10	Professional	TC	$23.99	$57.54	$87.10