Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.98 / $53.70 / $79.43	Facility	26	$48.98	$53.70	$79.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $169.82 / $398.11	Professional		$131.83	$169.82	$398.11
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $66.07 / $147.91	Professional	26	$48.98	$66.07	$147.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $104.71 / $218.78	Professional	TC	$83.18	$104.71	$218.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $128.82 / $263.03	Professional		$102.33	$128.82	$263.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $52.48 / $93.33	Professional	26	$38.02	$52.48	$93.33
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $97.72 / $165.96	Professional	TC	$79.43	$97.72	$165.96
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $131.83 / $151.36	Professional		$109.65	$131.83	$151.36
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $47.86 / $52.48	Professional	26	$40.74	$47.86	$52.48
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $79.43 / $89.13	Professional	TC	$67.61	$79.43	$89.13
CareSource Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $87.10 / $165.96	Professional		$52.48	$87.10	$165.96
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.59 / $57.54 / $83.18	Facility	26	$12.59	$57.54	$83.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $234.42 / $660.69	Professional		$138.04	$234.42	$660.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $85.11 / $234.42	Professional	26	$47.86	$85.11	$234.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $151.36 / $416.87	Professional	TC	$87.10	$151.36	$416.87
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $114.82	Professional		$32.36	$33.11	$114.82
United Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $158.49 / $245.47	Professional		$138.04	$158.49	$245.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $56.23 / $91.20	Professional	26	$48.98	$56.23	$91.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $102.33 / $154.88	Professional	TC	$87.10	$102.33	$154.88