Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $82.95 / $179.42 / $904.65	Facility		$82.95	$179.42	$904.65
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.82 / $20.78 / $45.60	Facility	26	$19.82	$20.78	$45.60
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $60.30 / $62.17 / $133.82	Facility	TC	$60.30	$62.17	$133.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $74.77 / $94.20 / $189.36	Professional		$74.77	$94.20	$189.36
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.82 / $22.30 / $40.38	Professional	26	$19.82	$22.30	$40.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $59.10 / $71.90 / $148.97	Professional	TC	$59.10	$71.90	$148.97
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $59.71 / $97.22 / $99.17	Professional		$59.71	$97.22	$99.17
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $16.55 / $24.48 / $33.60	Professional	26	$16.55	$24.48	$33.60
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $50.52 / $50.52 / $50.52	Professional	TC	$50.52	$50.52	$50.52
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $14.98 / $31.61 / $106.93	Professional		$14.98	$31.61	$106.93
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.23 / $11.23 / $37.68	Professional	26	$11.23	$11.23	$37.68
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $3.75 / $23.06 / $70.64	Professional	TC	$3.75	$23.06	$70.64
CareSource Facility/Professional Facility Modifier Low / Median / High Price $29.14 / $100.85 / $136.11	Facility		$29.14	$100.85	$136.11
CareSource Facility/Professional Professional Modifier Low / Median / High Price $28.56 / $91.51 / $136.11	Professional		$28.56	$91.51	$136.11
Cigna Facility/Professional Facility Modifier Low / Median / High Price $180.72 / $180.72 / $180.72	Facility		$180.72	$180.72	$180.72
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.57 / $45.57 / $45.57	Facility	26	$45.57	$45.57	$45.57
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $135.15 / $135.15 / $135.15	Facility	TC	$135.15	$135.15	$135.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $50.19 / $86.56 / $154.09	Professional		$50.19	$86.56	$154.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.20 / $32.92 / $57.79	Professional	26	$12.20	$32.92	$57.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.04 / $48.73 / $116.04	Professional	TC	$38.04	$48.73	$116.04
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $32.34	Professional		$32.34	$32.34	$32.34
United Facility/Professional Professional Modifier Low / Median / High Price $70.65 / $96.10 / $190.28	Professional		$70.65	$96.10	$190.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.57 / $27.79 / $42.81	Professional	26	$16.57	$27.79	$42.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $42.08 / $71.45 / $137.37	Professional	TC	$42.08	$71.45	$137.37