Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $25.44 / $138.11 / $402.70	Facility		$25.44	$138.11	$402.70
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.48 / $9.69 / $13.15	Facility	26	$6.48	$9.69	$13.15
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $18.16 / $29.35 / $164.39	Facility	TC	$18.16	$29.35	$164.39
Aetna Facility/Professional Professional Modifier Low / Median / High Price $24.62 / $30.16 / $103.50	Professional		$24.62	$30.16	$103.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.71 / $7.83 / $34.02	Professional	26	$6.71	$7.83	$34.02
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $21.90 / $88.68 / $88.68	Professional	50	$21.90	$88.68	$88.68
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $11.63 / $13.22 / $19.10	Professional	52	$11.63	$13.22	$19.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.34 / $20.13 / $36.25	Professional	TC	$17.34	$20.13	$36.25
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $21.05 / $27.37 / $37.15	Professional		$21.05	$27.37	$37.15
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.46 / $8.27 / $12.92	Professional	26	$5.46	$8.27	$12.92
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $31.80 / $31.80 / $31.80	Professional	50	$31.80	$31.80	$31.80
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $17.88 / $17.88 / $23.19	Professional	TC	$17.88	$17.88	$23.19
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $21.87 / $25.53 / $42.61	Professional		$21.87	$25.53	$42.61
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.22 / $8.50 / $13.58	Professional	26	$7.22	$8.50	$13.58
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $32.79 / $38.29 / $63.91	Professional	50	$32.79	$38.29	$63.91
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $14.47 / $17.03 / $28.89	Professional	TC	$14.47	$17.03	$28.89
CareSource Facility/Professional Facility Modifier Low / Median / High Price $7.68 / $24.14 / $35.92	Facility		$7.68	$24.14	$35.92
CareSource Facility/Professional Professional Modifier Low / Median / High Price $7.84 / $20.56 / $34.68	Professional		$7.84	$20.56	$34.68
Cigna Facility/Professional Facility Modifier Low / Median / High Price $32.07 / $32.07 / $163.03	Facility		$32.07	$32.07	$163.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.51 / $8.51 / $8.51	Facility	26	$8.51	$8.51	$8.51
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $23.86 / $23.86 / $23.86	Facility	TC	$23.86	$23.86	$23.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $24.41 / $36.81 / $54.50	Professional		$24.41	$36.81	$54.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.29 / $10.94 / $17.32	Professional	26	$7.29	$10.94	$17.32
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.88 / $26.83 / $39.63	Professional	TC	$17.88	$26.83	$39.63
Molina Facility/Professional Professional Modifier Low / Median / High Price $13.87 / $32.34 / $32.34	Professional		$13.87	$32.34	$32.34
United Facility/Professional Professional Modifier Low / Median / High Price $22.63 / $28.16 / $42.23	Professional		$22.63	$28.16	$42.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.89 / $8.09 / $11.91	Professional	26	$6.89	$8.09	$11.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $15.74 / $19.12 / $27.17	Professional	TC	$15.74	$19.12	$27.17