Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.15 / $25.15 / $25.15	Facility	26	$25.15	$25.15	$25.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $80.33 / $89.51 / $258.00	Professional		$80.33	$89.51	$258.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.88 / $26.88 / $55.54	Professional	26	$24.88	$26.88	$55.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $55.45 / $62.63 / $202.44	Professional	TC	$55.45	$62.63	$202.44
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $105.65 / $140.12 / $292.54	Professional		$105.65	$140.12	$292.54
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $27.81 / $48.14 / $91.01	Professional	26	$27.81	$48.14	$91.01
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $75.91 / $91.98 / $192.03	Professional	TC	$75.91	$91.98	$192.03
CareSource Facility/Professional Professional Modifier Low / Median / High Price $35.88 / $64.08 / $143.81	Professional		$35.88	$64.08	$143.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.17 / $69.17 / $69.17	Facility	26	$69.17	$69.17	$69.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $49.50 / $144.25 / $409.81	Professional		$49.50	$144.25	$409.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.27 / $42.26 / $112.48	Professional	26	$15.27	$42.26	$112.48
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $34.22 / $93.92 / $308.93	Professional	TC	$34.22	$93.92	$308.93
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 $64.42 / $138.16 / $241.29	Professional		$64.42	$138.16	$241.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.37 / $47.33 / $80.63	Professional	26	$30.37	$47.33	$80.63
United Facility/Professional Professional Modifier TC Low / Median / High Price $69.37 / $111.13 / $182.00	Professional	TC	$69.37	$111.13	$182.00