Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $96.41 / $321.30 / $700.43	Facility		$96.41	$321.30	$700.43
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.83 / $23.84 / $34.60	Facility	26	$23.83	$23.84	$34.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $112.95 / $122.77 / $265.89	Professional		$112.95	$122.77	$265.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.50 / $23.84 / $41.66	Professional	26	$20.50	$23.84	$41.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $91.13 / $99.16 / $155.07	Professional	TC	$91.13	$99.16	$155.07
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $112.08 / $186.63 / $186.63	Professional		$112.08	$186.63	$186.63
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $17.30 / $38.72 / $38.72	Professional	26	$17.30	$38.72	$38.72
BCBS Facility/Professional Facility Modifier Low / Median / High Price $203.74 / $353.47 / $567.75	Facility		$203.74	$353.47	$567.75
BCBS Facility/Professional Professional Modifier Low / Median / High Price $104.26 / $148.00 / $260.23	Professional		$104.26	$148.00	$260.23
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $21.63 / $30.00 / $45.97	Professional	26	$21.63	$30.00	$45.97
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $82.63 / $118.00 / $209.89	Professional	TC	$82.63	$118.00	$209.89
Cigna Facility/Professional Facility Modifier Low / Median / High Price $319.88 / $429.82 / $534.71	Facility		$319.88	$429.82	$534.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $119.82 / $159.94 / $242.38	Professional		$119.82	$159.94	$242.38
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.01 / $27.85 / $45.00	Professional	26	$22.01	$27.85	$45.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $95.73 / $133.53 / $199.45	Professional	TC	$95.73	$133.53	$199.45
Medcost Facility/Professional Facility Modifier Low / Median / High Price $116.90 / $182.97 / $251.10	Facility		$116.90	$182.97	$251.10
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $22.96 / $39.00 / $51.04	Facility	26	$22.96	$39.00	$51.04
Medcost Facility/Professional Professional Modifier Low / Median / High Price $420.81 / $420.81 / $420.81	Professional		$420.81	$420.81	$420.81
Medcost Facility/Professional Professional Modifier TC Low / Median / High Price $335.36 / $335.36 / $335.36	Professional	TC	$335.36	$335.36	$335.36
Molina Facility/Professional Professional Modifier Low / Median / High Price $44.14 / $120.74 / $186.97	Professional		$44.14	$120.74	$186.97
United Facility/Professional Professional Modifier Low / Median / High Price $107.38 / $146.34 / $248.05	Professional		$107.38	$146.34	$248.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.21 / $25.26 / $41.03	Professional	26	$20.21	$25.26	$41.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $85.40 / $123.85 / $207.23	Professional	TC	$85.40	$123.85	$207.23