Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.78 / $30.79 / $54.25	Facility	26	$30.78	$30.79	$54.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $104.90 / $124.76 / $447.95	Professional		$104.90	$124.76	$447.95
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.79 / $34.17 / $131.75	Professional	26	$30.79	$34.17	$131.75
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $30.00 / $54.26 / $257.55	Professional	52	$30.00	$54.26	$257.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $74.09 / $91.89 / $144.90	Professional	TC	$74.09	$91.89	$144.90
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $95.22 / $95.22 / $124.36	Professional		$95.22	$95.22	$124.36
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $27.06 / $36.45 / $60.70	Professional	26	$27.06	$36.45	$60.70
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $23.80 / $23.80 / $23.80	Professional	52	$23.80	$23.80	$23.80
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $67.73 / $97.31 / $114.48	Professional	TC	$67.73	$97.31	$114.48
BCBS Facility/Professional Professional Modifier Low / Median / High Price $77.00 / $115.68 / $173.52	Professional		$77.00	$115.68	$173.52
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $26.00 / $35.97 / $53.24	Professional	26	$26.00	$35.97	$53.24
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $51.00 / $81.77 / $112.84	Professional	TC	$51.00	$81.77	$112.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $133.01 / $166.29 / $288.64	Professional		$133.01	$166.29	$288.64
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.90 / $47.28 / $90.19	Professional	26	$37.90	$47.28	$90.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $95.11 / $119.01 / $203.78	Professional	TC	$95.11	$119.01	$203.78
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $49.17 / $76.25 / $112.66	Facility	26	$49.17	$76.25	$112.66
Medcost Facility/Professional Professional Modifier Low / Median / High Price $458.90 / $458.90 / $458.90	Professional		$458.90	$458.90	$458.90
Medcost Facility/Professional Professional Modifier TC Low / Median / High Price $326.05 / $326.05 / $326.05	Professional	TC	$326.05	$326.05	$326.05
Molina Facility/Professional Professional Modifier Low / Median / High Price $44.14 / $118.03 / $177.87	Professional		$44.14	$118.03	$177.87
United Facility/Professional Professional Modifier Low / Median / High Price $125.38 / $167.17 / $264.69	Professional		$125.38	$167.17	$264.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.40 / $47.15 / $74.75	Professional	26	$35.40	$47.15	$74.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $90.41 / $114.97 / $179.95	Professional	TC	$90.41	$114.97	$179.95