Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $149.01 / $793.08 / $1,336.84	Facility		$149.01	$793.08	$1,336.84
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.78 / $41.79 / $41.79	Facility	26	$41.78	$41.79	$41.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $135.30 / $193.71 / $457.76	Professional		$135.30	$193.71	$457.76
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.86 / $54.92 / $143.00	Professional	26	$36.86	$54.92	$143.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $96.15 / $96.15 / $96.15	Professional	52	$96.15	$96.15	$96.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $96.60 / $131.38 / $196.80	Professional	TC	$96.60	$131.38	$196.80
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $115.94 / $119.18 / $208.69	Professional		$115.94	$119.18	$208.69
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.97 / $38.97 / $64.91	Professional	26	$38.97	$38.97	$64.91
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $85.66 / $85.66 / $85.66	Professional	TC	$85.66	$85.66	$85.66
BCBS Facility/Professional Facility Modifier Low / Median / High Price $337.46 / $635.13 / $940.62	Facility		$337.46	$635.13	$940.62
BCBS Facility/Professional Professional Modifier Low / Median / High Price $116.52 / $162.00 / $284.83	Professional		$116.52	$162.00	$284.83
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.26 / $47.00 / $82.64	Professional	26	$36.26	$47.00	$82.64
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $79.68 / $115.00 / $202.20	Professional	TC	$79.68	$115.00	$202.20
Cigna Facility/Professional Facility Modifier Low / Median / High Price $136.96 / $136.96 / $136.96	Facility		$136.96	$136.96	$136.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $175.43 / $235.98 / $316.05	Professional		$175.43	$235.98	$316.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.78 / $68.04 / $92.06	Professional	26	$45.78	$68.04	$92.06
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $128.81 / $164.94 / $220.03	Professional	TC	$128.81	$164.94	$220.03
Medcost Facility/Professional Facility Modifier Low / Median / High Price $149.01 / $235.92 / $297.88	Facility		$149.01	$235.92	$297.88
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $46.87 / $67.66 / $90.21	Facility	26	$46.87	$67.66	$90.21
Molina Facility/Professional Professional Modifier Low / Median / High Price $45.41 / $120.94 / $189.79	Professional		$45.41	$120.94	$189.79
United Facility/Professional Professional Modifier Low / Median / High Price $152.21 / $198.32 / $290.61	Professional		$152.21	$198.32	$290.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.77 / $51.21 / $87.39	Professional	26	$39.77	$51.21	$87.39
United Facility/Professional Professional Modifier TC Low / Median / High Price $112.22 / $141.65 / $251.92	Professional	TC	$112.22	$141.65	$251.92