Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $109.16 / $135.54 / $652.00	Facility		$109.16	$135.54	$652.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.93 / $27.02 / $41.99	Facility	26	$22.93	$27.02	$41.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.89 / $122.76 / $199.76	Professional		$107.89	$122.76	$199.76
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.69 / $22.95 / $41.10	Professional	26	$21.69	$22.95	$41.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $86.20 / $102.26 / $161.71	Professional	TC	$86.20	$102.26	$161.71
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $80.86 / $101.07 / $101.07	Professional		$80.86	$101.07	$101.07
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $17.57 / $17.57 / $17.57	Professional	26	$17.57	$17.57	$17.57
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $93.20 / $93.20 / $93.20	Professional	TC	$93.20	$93.20	$93.20
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $88.91 / $115.29 / $192.13	Professional		$88.91	$115.29	$192.13
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $17.62 / $22.87 / $33.32	Professional	26	$17.62	$22.87	$33.32
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $71.28 / $92.43 / $152.01	Professional	TC	$71.28	$92.43	$152.01
CareSource Facility/Professional Facility Modifier Low / Median / High Price $23.89 / $102.03 / $142.51	Facility		$23.89	$102.03	$142.51
CareSource Facility/Professional Professional Modifier Low / Median / High Price $23.51 / $34.59 / $149.81	Professional		$23.51	$34.59	$149.81
Cigna Facility/Professional Facility Modifier Low / Median / High Price $116.64 / $131.97 / $197.24	Facility		$116.64	$131.97	$197.24
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.06 / $27.06 / $27.06	Facility	26	$27.06	$27.06	$27.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $109.47 / $167.18 / $293.93	Professional		$109.47	$167.18	$293.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.55 / $30.76 / $47.99	Professional	26	$22.55	$30.76	$47.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $87.22 / $138.37 / $250.49	Professional	TC	$87.22	$138.37	$250.49
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $96.57	Professional		$32.34	$32.34	$96.57
United Facility/Professional Facility Modifier Low / Median / High Price $110.74 / $110.74 / $110.74	Facility		$110.74	$110.74	$110.74
United Facility/Professional Professional Modifier Low / Median / High Price $108.98 / $158.04 / $229.72	Professional		$108.98	$158.04	$229.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.27 / $27.72 / $49.88	Professional	26	$20.27	$27.72	$49.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $86.95 / $131.38 / $179.58	Professional	TC	$86.95	$131.38	$179.58