Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.39 / $9.39 / $16.52	Facility	26	$9.39	$9.39	$16.52
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $28.60 / $364.29 / $764.12	Facility	TC	$28.60	$364.29	$764.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.92 / $46.25 / $140.66	Professional		$28.92	$46.25	$140.66
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.39 / $11.83 / $56.10	Professional	26	$9.39	$11.83	$56.10
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $42.49 / $124.11 / $475.80	Professional	50	$42.49	$124.11	$475.80
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $15.08 / $18.98 / $21.90	Professional	52	$15.08	$18.98	$21.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.87 / $33.09 / $75.93	Professional	TC	$27.87	$33.09	$75.93
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $42.49 / $72.23 / $76.06	Professional		$42.49	$72.23	$76.06
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.27 / $11.36 / $18.48	Professional	26	$8.27	$11.36	$18.48
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $63.74 / $96.97 / $114.09	Professional	50	$63.74	$96.97	$114.09
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $35.38 / $45.02 / $57.57	Professional	TC	$35.38	$45.02	$57.57
BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $54.00 / $72.00 / $408.90	Facility	TC	$54.00	$72.00	$408.90
BCBS Facility/Professional Professional Modifier Low / Median / High Price $42.49 / $48.70 / $89.91	Professional		$42.49	$48.70	$89.91
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.33 / $26.50 / $35.28	Professional	26	$10.33	$26.50	$35.28
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $16.50 / $32.15 / $48.83	Professional	TC	$16.50	$32.15	$48.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.56 / $49.29 / $91.79	Professional		$34.56	$49.29	$91.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.39 / $14.70 / $26.88	Professional	26	$10.39	$14.70	$26.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $24.60 / $35.00 / $66.79	Professional	TC	$24.60	$35.00	$66.79
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $16.26 / $19.00 / $33.10	Facility	26	$16.26	$19.00	$33.10
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $39.01 / $58.82 / $91.28	Facility	TC	$39.01	$58.82	$91.28
Medcost Facility/Professional Professional Modifier Low / Median / High Price $164.83 / $164.83 / $164.83	Professional		$164.83	$164.83	$164.83
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $39.71 / $39.71 / $39.71	Professional	26	$39.71	$39.71	$39.71
Medcost Facility/Professional Professional Modifier 50 Low / Median / High Price $247.24 / $247.24 / $247.24	Professional	50	$247.24	$247.24	$247.24
Molina Facility/Professional Professional Modifier Low / Median / High Price $25.48 / $34.77 / $51.41	Professional		$25.48	$34.77	$51.41
United Facility/Professional Professional Modifier Low / Median / High Price $34.02 / $51.00 / $84.64	Professional		$34.02	$51.00	$84.64
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.28 / $13.64 / $22.73	Professional	26	$10.28	$13.64	$22.73
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.61 / $35.69 / $61.59	Professional	TC	$24.61	$35.69	$61.59