Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $144.75 / $399.00 / $814.97	Facility		$144.75	$399.00	$814.97
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.24 / $24.64 / $52.22	Facility	26	$22.24	$24.64	$52.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $122.46 / $167.78 / $302.06	Professional		$122.46	$167.78	$302.06
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.84 / $23.55 / $43.65	Professional	26	$19.84	$23.55	$43.65
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $61.23 / $63.75 / $89.13	Professional	52	$61.23	$63.75	$89.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $102.37 / $136.81 / $209.65	Professional	TC	$102.37	$136.81	$209.65
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $119.38 / $124.59 / $124.59	Professional		$119.38	$124.59	$124.59
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $15.77 / $35.29 / $35.29	Professional	26	$15.77	$35.29	$35.29
BCBS Facility/Professional Facility Modifier Low / Median / High Price $187.08 / $367.60 / $632.05	Facility		$187.08	$367.60	$632.05
BCBS Facility/Professional Professional Modifier Low / Median / High Price $115.90 / $155.47 / $244.03	Professional		$115.90	$155.47	$244.03
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.72 / $46.00 / $63.70	Professional	26	$19.72	$46.00	$63.70
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $96.18 / $114.78 / $191.63	Professional	TC	$96.18	$114.78	$191.63
Cigna Facility/Professional Facility Modifier Low / Median / High Price $454.49 / $577.30 / $786.74	Facility		$454.49	$577.30	$786.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $131.00 / $179.59 / $263.66	Professional		$131.00	$179.59	$263.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.08 / $27.27 / $43.00	Professional	26	$21.08	$27.27	$43.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $108.44 / $155.16 / $218.43	Professional	TC	$108.44	$155.16	$218.43
Medcost Facility/Professional Facility Modifier Low / Median / High Price $127.49 / $183.00 / $288.26	Facility		$127.49	$183.00	$288.26
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $24.95 / $40.00 / $52.45	Facility	26	$24.95	$40.00	$52.45
Medcost Facility/Professional Professional Modifier Low / Median / High Price $456.69 / $456.69 / $456.69	Professional		$456.69	$456.69	$456.69
Medcost Facility/Professional Professional Modifier TC Low / Median / High Price $376.72 / $376.72 / $376.72	Professional	TC	$376.72	$376.72	$376.72
Molina Facility/Professional Professional Modifier Low / Median / High Price $77.94 / $107.83 / $162.73	Professional		$77.94	$107.83	$162.73
United Facility/Professional Professional Modifier Low / Median / High Price $120.50 / $162.63 / $273.02	Professional		$120.50	$162.63	$273.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.59 / $23.42 / $41.12	Professional	26	$19.59	$23.42	$41.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $98.10 / $140.06 / $230.48	Professional	TC	$98.10	$140.06	$230.48