Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $102.96 / $104.46 / $126.71	Facility	26	$102.96	$104.46	$126.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $339.81 / $384.07 / $637.00	Professional		$339.81	$384.07	$637.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.50 / $110.37 / $199.56	Professional	26	$102.50	$110.37	$199.56
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $262.70 / $262.70 / $262.70	Professional	52	$262.70	$262.70	$262.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $229.43 / $269.79 / $432.76	Professional	TC	$229.43	$269.79	$432.76
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $251.88 / $305.22 / $445.28	Professional		$251.88	$305.22	$445.28
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $93.19 / $110.93 / $143.18	Professional	26	$93.19	$110.93	$143.18
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $158.68 / $192.29 / $308.89	Professional	TC	$158.68	$192.29	$308.89
CareSource Facility/Professional Professional Modifier Low / Median / High Price $108.15 / $231.66 / $415.59	Professional		$108.15	$231.66	$415.59
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $117.49 / $117.49 / $117.49	Facility	26	$117.49	$117.49	$117.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $298.13 / $409.31 / $641.12	Professional		$298.13	$409.31	$641.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $101.72 / $149.15 / $225.98	Professional	26	$101.72	$149.15	$225.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $186.40 / $262.80 / $433.82	Professional	TC	$186.40	$262.80	$433.82
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $32.34	Professional		$32.34	$32.34	$32.34
United Facility/Professional Professional Modifier Low / Median / High Price $288.72 / $409.08 / $648.30	Professional		$288.72	$409.08	$648.30
United Facility/Professional Professional Modifier 26 Low / Median / High Price $103.55 / $148.94 / $210.93	Professional	26	$103.55	$148.94	$210.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $164.80 / $247.20 / $435.86	Professional	TC	$164.80	$247.20	$435.86