Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $77.76 / $262.89 / $575.76	Facility		$77.76	$262.89	$575.76
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.46 / $31.67 / $57.26	Facility	26	$28.46	$31.67	$57.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $92.36 / $405.00	Professional		$70.79	$92.36	$405.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.67 / $34.14 / $125.93	Professional	26	$29.67	$34.14	$125.93
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $111.81 / $547.27 / $663.00	Professional	50	$111.81	$547.27	$663.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.40 / $54.25 / $102.34	Professional	TC	$43.40	$54.25	$102.34
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $63.60 / $95.40 / $112.23	Professional		$63.60	$95.40	$112.23
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $24.22 / $30.27 / $47.89	Professional	26	$24.22	$30.27	$47.89
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $97.87 / $143.09 / $168.35	Professional	50	$97.87	$143.09	$168.35
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $35.64 / $49.67 / $57.92	Professional	TC	$35.64	$49.67	$57.92
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $138.00 / $138.00 / $138.00	Facility		$138.00	$138.00	$138.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $76.26 / $78.55 / $108.33	Professional		$76.26	$78.55	$108.33
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $28.44 / $29.29 / $43.49	Professional	26	$28.44	$29.29	$43.49
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $114.39 / $117.82 / $162.50	Professional	50	$114.39	$117.82	$162.50
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $47.82 / $49.25 / $63.83	Professional	TC	$47.82	$49.25	$63.83
CareSource Facility/Professional Facility Modifier Low / Median / High Price $30.70 / $57.51 / $104.75	Facility		$30.70	$57.51	$104.75
CareSource Facility/Professional Professional Modifier Low / Median / High Price $33.29 / $51.23 / $101.01	Professional		$33.29	$51.23	$101.01
Cigna Facility/Professional Facility Modifier Low / Median / High Price $95.07 / $95.07 / $163.03	Facility		$95.07	$95.07	$163.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.03 / $37.03 / $37.03	Facility	26	$37.03	$37.03	$37.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $72.45 / $110.94 / $188.21	Professional		$72.45	$110.94	$188.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.04 / $44.56 / $77.36	Professional	26	$29.04	$44.56	$77.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $46.43 / $66.81 / $110.85	Professional	TC	$46.43	$66.81	$110.85
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $70.34	Professional		$32.34	$32.34	$70.34
United Facility/Professional Professional Modifier Low / Median / High Price $73.98 / $90.52 / $128.71	Professional		$73.98	$90.52	$128.71
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.99 / $36.99 / $52.94	Professional	26	$29.99	$36.99	$52.94
United Facility/Professional Professional Modifier TC Low / Median / High Price $45.23 / $52.89 / $73.88	Professional	TC	$45.23	$52.89	$73.88