Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $82.50 / $118.75 / $160.97	Facility	26	$82.50	$118.75	$160.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $257.92 / $406.22 / $661.50	Professional		$257.92	$406.22	$661.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $82.50 / $122.02 / $179.28	Professional	26	$82.50	$122.02	$179.28
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $128.96 / $139.68 / $237.50	Professional	52	$128.96	$139.68	$237.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $175.43 / $273.70 / $462.42	Professional	TC	$175.43	$273.70	$462.42
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $62.57 / $63.52 / $97.98	Professional	26	$62.57	$63.52	$97.98
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $290.23 / $374.87 / $573.17	Professional		$290.23	$374.87	$573.17
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $84.20 / $99.06 / $150.41	Professional	26	$84.20	$99.06	$150.41
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $206.03 / $269.14 / $432.85	Professional	TC	$206.03	$269.14	$432.85
CareSource Facility/Professional Professional Modifier Low / Median / High Price $86.61 / $129.33 / $337.34	Professional		$86.61	$129.33	$337.34
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.46 / $96.46 / $96.46	Facility	26	$96.46	$96.46	$96.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $323.55 / $598.38 / $1,108.93	Professional		$323.55	$598.38	$1,108.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.90 / $132.51 / $202.34	Professional	26	$77.90	$132.51	$202.34
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $223.50 / $479.11 / $934.80	Professional	TC	$223.50	$479.11	$934.80
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $377.80	Professional		$32.34	$32.34	$377.80
United Facility/Professional Professional Modifier Low / Median / High Price $272.85 / $469.48 / $689.01	Professional		$272.85	$469.48	$689.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $80.15 / $91.63 / $127.84	Professional	26	$80.15	$91.63	$127.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $196.39 / $311.23 / $602.65	Professional	TC	$196.39	$311.23	$602.65