Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $102.22 / $826.69 / $1,228.53	Facility		$102.22	$826.69	$1,228.53
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.19 / $21.60 / $37.07	Facility	26	$21.19	$21.60	$37.07
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $88.12 / $163.85 / $497.84	Facility	TC	$88.12	$163.85	$497.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $32.07 / $127.14 / $431.12	Professional		$32.07	$127.14	$431.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.26 / $27.35 / $93.00	Professional	26	$20.26	$27.35	$93.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $89.54 / $102.26 / $168.67	Professional	TC	$89.54	$102.26	$168.67
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $81.81 / $113.89 / $153.41	Professional		$81.81	$113.89	$153.41
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $15.36 / $18.37 / $25.23	Professional	26	$15.36	$18.37	$25.23
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $70.43 / $82.86 / $107.72	Professional	TC	$70.43	$82.86	$107.72
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $89.19 / $106.94 / $170.80	Professional		$89.19	$106.94	$170.80
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $17.91 / $21.99 / $33.74	Professional	26	$17.91	$21.99	$33.74
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $71.28 / $86.30 / $136.68	Professional	TC	$71.28	$86.30	$136.68
CareSource Facility/Professional Facility Modifier Low / Median / High Price $19.75 / $101.48 / $148.29	Facility		$19.75	$101.48	$148.29
CareSource Facility/Professional Professional Modifier Low / Median / High Price $21.35 / $95.29 / $143.18	Professional		$21.35	$95.29	$143.18
Cigna Facility/Professional Facility Modifier Low / Median / High Price $116.64 / $133.10 / $197.24	Facility		$116.64	$133.10	$197.24
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.98 / $23.98 / $23.98	Facility	26	$23.98	$23.98	$23.98
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $109.98 / $109.98 / $109.98	Facility	TC	$109.98	$109.98	$109.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $108.45 / $172.78 / $290.83	Professional		$108.45	$172.78	$290.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.41 / $29.84 / $46.39	Professional	26	$20.41	$29.84	$46.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $90.05 / $142.16 / $246.78	Professional	TC	$90.05	$142.16	$246.78
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $102.93	Professional		$32.34	$32.34	$102.93
United Facility/Professional Professional Modifier Low / Median / High Price $111.69 / $158.66 / $231.20	Professional		$111.69	$158.66	$231.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.94 / $27.16 / $44.81	Professional	26	$19.94	$27.16	$44.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $88.23 / $136.72 / $185.68	Professional	TC	$88.23	$136.72	$185.68