Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $108.83 / $130.59 / $208.12	Facility	26	$108.83	$130.59	$208.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $266.20 / $383.68 / $515.60	Professional		$266.20	$383.68	$515.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.37 / $113.73 / $259.89	Professional	26	$104.37	$113.73	$259.89
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $157.38 / $230.14 / $385.70	Professional	TC	$157.38	$230.14	$385.70
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $83.06 / $114.90 / $169.35	Professional	26	$83.06	$114.90	$169.35
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $250.48 / $250.48 / $250.48	Professional	TC	$250.48	$250.48	$250.48
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $309.33 / $388.10 / $630.17	Professional		$309.33	$388.10	$630.17
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $96.91 / $121.38 / $194.64	Professional	26	$96.91	$121.38	$194.64
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $190.00 / $272.00 / $418.60	Professional	TC	$190.00	$272.00	$418.60
CareSource Facility/Professional Professional Modifier Low / Median / High Price $119.86 / $299.20 / $510.48	Professional		$119.86	$299.20	$510.48
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $128.28 / $128.28 / $128.28	Facility	26	$128.28	$128.28	$128.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $450.00 / $693.73 / $1,107.59	Professional		$450.00	$693.73	$1,107.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $105.42 / $165.29 / $272.25	Professional	26	$105.42	$165.29	$272.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $322.42 / $521.69 / $910.20	Professional	TC	$322.42	$521.69	$910.20
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $312.89	Professional		$32.34	$32.34	$312.89
United Facility/Professional Professional Modifier Low / Median / High Price $392.16 / $531.61 / $799.53	Professional		$392.16	$531.61	$799.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $105.71 / $128.21 / $179.23	Professional	26	$105.71	$128.21	$179.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $287.89 / $404.69 / $591.08	Professional	TC	$287.89	$404.69	$591.08