Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $38.93 / $107.01 / $294.51	Facility		$38.93	$107.01	$294.51
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.50 / $30.15 / $35.65	Facility	26	$25.50	$30.15	$35.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $39.11 / $80.39 / $202.45	Professional		$39.11	$80.39	$202.45
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.50 / $33.15 / $64.68	Professional	26	$25.50	$33.15	$64.68
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $115.29 / $209.18 / $334.86	Professional	50	$115.29	$209.18	$334.86
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $19.47 / $23.39 / $53.51	Professional	52	$19.47	$23.39	$53.51
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $13.91 / $32.35 / $87.90	Professional	TC	$13.91	$32.35	$87.90
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $52.71 / $59.04 / $59.04	Professional		$52.71	$59.04	$59.04
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $34.26 / $34.26 / $61.67	Professional	26	$34.26	$34.26	$61.67
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $22.14 / $22.14 / $22.14	Professional	TC	$22.14	$22.14	$22.14
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $53.90 / $67.59 / $116.29	Professional		$53.90	$67.59	$116.29
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $23.71 / $27.90 / $41.99	Professional	26	$23.71	$27.90	$41.99
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $80.86 / $100.27 / $174.44	Professional	50	$80.86	$100.27	$174.44
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $30.18 / $39.67 / $78.83	Professional	TC	$30.18	$39.67	$78.83
CareSource Facility/Professional Facility Modifier Low / Median / High Price $15.37 / $33.79 / $59.04	Facility		$15.37	$33.79	$59.04
CareSource Facility/Professional Professional Modifier Low / Median / High Price $16.23 / $31.52 / $59.04	Professional		$16.23	$31.52	$59.04
Cigna Facility/Professional Facility Modifier Low / Median / High Price $52.57 / $52.57 / $59.88	Facility		$52.57	$52.57	$59.88
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.84 / $33.84 / $33.84	Facility	26	$33.84	$33.84	$33.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $43.40 / $89.89 / $157.15	Professional		$43.40	$89.89	$157.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.87 / $37.72 / $64.51	Professional	26	$25.87	$37.72	$64.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.23 / $54.40 / $100.03	Professional	TC	$16.23	$54.40	$100.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $15.51 / $32.34 / $41.30	Professional		$15.51	$32.34	$41.30
United Facility/Professional Professional Modifier Low / Median / High Price $52.14 / $73.86 / $107.65	Professional		$52.14	$73.86	$107.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.46 / $31.76 / $44.20	Professional	26	$24.46	$31.76	$44.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.97 / $41.52 / $67.13	Professional	TC	$24.97	$41.52	$67.13