Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $97.15 / $693.42 / $1,172.16	Facility		$97.15	$693.42	$1,172.16
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.01 / $24.35 / $31.16	Facility	26	$22.01	$24.35	$31.16
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $97.01 / $374.08 / $862.20	Facility	TC	$97.01	$374.08	$862.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $32.07 / $130.50 / $754.12	Professional		$32.07	$130.50	$754.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.05 / $28.42 / $112.21	Professional	26	$20.05	$28.42	$112.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $94.40 / $103.36 / $183.21	Professional	TC	$94.40	$103.36	$183.21
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $87.19 / $113.58 / $160.83	Professional		$87.19	$113.58	$160.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $15.52 / $23.78 / $34.86	Professional	26	$15.52	$23.78	$34.86
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $86.17 / $120.64 / $120.64	Professional	TC	$86.17	$120.64	$120.64
BCBS Facility/Professional Facility Modifier Low / Median / High Price $164.30 / $353.47 / $655.70	Facility		$164.30	$353.47	$655.70
BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $151.47 / $251.09 / $886.09	Facility	TC	$151.47	$251.09	$886.09
BCBS Facility/Professional Professional Modifier Low / Median / High Price $105.66 / $163.00 / $277.81	Professional		$105.66	$163.00	$277.81
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.48 / $32.00 / $47.71	Professional	26	$19.48	$32.00	$47.71
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $86.17 / $126.00 / $223.24	Professional	TC	$86.17	$126.00	$223.24
Cigna Facility/Professional Facility Modifier Low / Median / High Price $319.88 / $443.79 / $534.71	Facility		$319.88	$443.79	$534.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $118.01 / $165.00 / $241.21	Professional		$118.01	$165.00	$241.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.85 / $27.09 / $42.65	Professional	26	$20.85	$27.09	$42.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $94.79 / $138.91 / $197.10	Professional	TC	$94.79	$138.91	$197.10
Medcost Facility/Professional Facility Modifier Low / Median / High Price $119.04 / $186.71 / $260.79	Facility		$119.04	$186.71	$260.79
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $23.88 / $40.00 / $66.00	Facility	26	$23.88	$40.00	$66.00
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $97.89 / $143.96 / $234.08	Facility	TC	$97.89	$143.96	$234.08
Medcost Facility/Professional Professional Modifier Low / Median / High Price $427.58 / $427.58 / $427.58	Professional		$427.58	$427.58	$427.58
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $78.02 / $78.02 / $78.02	Professional	26	$78.02	$78.02	$78.02
Medcost Facility/Professional Professional Modifier 50 Low / Median / High Price $641.37 / $641.37 / $641.37	Professional	50	$641.37	$641.37	$641.37
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 $108.01 / $146.00 / $250.08	Professional		$108.01	$146.00	$250.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.32 / $23.88 / $47.08	Professional	26	$19.32	$23.88	$47.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $87.90 / $125.61 / $216.33	Professional	TC	$87.90	$125.61	$216.33