Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.97 / $38.71 / $67.01	Facility	26	$37.97	$38.71	$67.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $175.63 / $224.58 / $645.00	Professional		$175.63	$224.58	$645.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.13 / $38.71 / $80.29	Professional	26	$31.13	$38.71	$80.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $139.01 / $162.49 / $259.95	Professional	TC	$139.01	$162.49	$259.95
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $121.78 / $146.59 / $244.08	Professional		$121.78	$146.59	$244.08
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.02 / $37.29 / $49.03	Professional	26	$28.02	$37.29	$49.03
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $127.69 / $162.80 / $162.80	Professional	TC	$127.69	$162.80	$162.80
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $136.63 / $170.64 / $268.51	Professional		$136.63	$170.64	$268.51
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $24.02 / $31.31 / $52.94	Professional	26	$24.02	$31.31	$52.94
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $112.60 / $136.44 / $216.91	Professional	TC	$112.60	$136.44	$216.91
CareSource Facility/Professional Professional Modifier Low / Median / High Price $38.52 / $146.84 / $227.81	Professional		$38.52	$146.84	$227.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.27 / $43.27 / $43.27	Facility	26	$43.27	$43.27	$43.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $172.46 / $272.58 / $450.83	Professional		$172.46	$272.58	$450.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.84 / $44.96 / $78.95	Professional	26	$31.84	$44.96	$78.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $144.56 / $223.14 / $379.94	Professional	TC	$144.56	$223.14	$379.94
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $174.51	Professional		$32.34	$32.34	$174.51
United Facility/Professional Professional Modifier Low / Median / High Price $181.39 / $255.68 / $372.49	Professional		$181.39	$255.68	$372.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.26 / $40.78 / $80.30	Professional	26	$29.26	$40.78	$80.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $142.61 / $205.11 / $297.27	Professional	TC	$142.61	$205.11	$297.27