Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $30.76 / $76.73 / $294.51	Facility		$30.76	$76.73	$294.51
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.86 / $22.07 / $28.65	Facility	26	$17.86	$22.07	$28.65
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $12.90 / $240.10 / $372.39	Facility	TC	$12.90	$240.10	$372.39
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.76 / $62.60 / $115.00	Professional		$30.76	$62.60	$115.00
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $71.59 / $71.59 / $71.59	Professional	25	$71.59	$71.59	$71.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.36 / $22.07 / $40.10	Professional	26	$17.36	$22.07	$40.10
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $234.74 / $234.74 / $281.35	Professional	50	$234.74	$234.74	$281.35
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $15.37 / $17.47 / $38.36	Professional	52	$15.37	$17.47	$38.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $13.18 / $30.45 / $83.52	Professional	TC	$13.18	$30.45	$83.52
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $32.14 / $32.82 / $45.95	Professional		$32.14	$32.82	$45.95
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $23.64 / $23.64 / $23.64	Professional	26	$23.64	$23.64	$23.64
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $38.92 / $54.00 / $106.70	Professional		$38.92	$54.00	$106.70
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $17.12 / $20.72 / $36.06	Professional	26	$17.12	$20.72	$36.06
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $58.38 / $77.29 / $160.05	Professional	50	$58.38	$77.29	$160.05
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $19.64 / $34.79 / $70.31	Professional	TC	$19.64	$34.79	$70.31
CareSource Facility/Professional Facility Modifier Low / Median / High Price $15.37 / $25.88 / $47.59	Facility		$15.37	$25.88	$47.59
CareSource Facility/Professional Professional Modifier Low / Median / High Price $15.93 / $23.64 / $45.95	Professional		$15.93	$23.64	$45.95
Cigna Facility/Professional Facility Modifier Low / Median / High Price $41.38 / $41.38 / $51.36	Facility		$41.38	$41.38	$51.36
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.35 / $23.35 / $23.35	Facility	26	$23.35	$23.35	$23.35
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $18.64 / $18.64 / $18.64	Facility	TC	$18.64	$18.64	$18.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $38.78 / $81.84 / $137.80	Professional		$38.78	$81.84	$137.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.46 / $30.64 / $50.06	Professional	26	$20.46	$30.64	$50.06
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.39 / $52.82 / $93.47	Professional	TC	$17.39	$52.82	$93.47
Molina Facility/Professional Professional Modifier Low / Median / High Price $18.13 / $32.34 / $42.67	Professional		$18.13	$32.34	$42.67
United Facility/Professional Professional Modifier Low / Median / High Price $38.82 / $57.12 / $90.79	Professional		$38.82	$57.12	$90.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.01 / $22.28 / $35.34	Professional	26	$19.01	$22.28	$35.34
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.77 / $35.69 / $57.31	Professional	TC	$19.77	$35.69	$57.31