Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $173.78 / $186.21 / $223.87	Facility	26	$173.78	$186.21	$223.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $794.33 / $1,659.59	Professional		$575.44	$794.33	$1,659.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $151.36 / $562.34	Professional	26	$114.82	$151.36	$562.34
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $199.53 / $295.12 / $1,258.93	Professional	52	$199.53	$295.12	$1,258.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $446.68 / $616.60 / $1,023.29	Professional	TC	$446.68	$616.60	$1,023.29
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $562.34 / $562.34 / $562.34	Professional		$562.34	$562.34	$562.34
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $104.71 / $112.20	Professional	26	$104.71	$104.71	$112.20
BCBS Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $446.68 / $660.69	Professional		$114.82	$446.68	$660.69
Cigna Facility/Professional Professional Modifier Low / Median / High Price $724.44 / $1,047.13 / $1,258.93	Professional		$724.44	$1,047.13	$1,258.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $199.53 / $257.04	Professional	26	$131.83	$199.53	$257.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $588.84 / $851.14 / $1,023.29	Professional	TC	$588.84	$851.14	$1,023.29
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $891.25	Professional		$32.36	$33.11	$891.25
Providence Facility/Professional Professional Modifier Low / Median / High Price $691.83 / $1,000.00 / $1,258.93	Professional		$691.83	$1,000.00	$1,258.93
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $181.97 / $234.42	Professional	26	$128.82	$181.97	$234.42
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $549.54 / $812.83 / $1,023.29	Professional	TC	$549.54	$812.83	$1,023.29
United Facility/Professional Professional Modifier Low / Median / High Price $758.58 / $1,096.48 / $1,584.89	Professional		$758.58	$1,096.48	$1,584.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $144.54 / $218.78 / $316.23	Professional	26	$144.54	$218.78	$316.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $616.60 / $870.96 / $1,288.25	Professional	TC	$616.60	$870.96	$1,288.25