Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $119.52 / $219.39 / $388.66	Facility		$119.52	$219.39	$388.66
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.23 / $23.68 / $41.59	Facility	26	$23.23	$23.68	$41.59
Aetna Facility/Professional Professional Modifier Low / Median / High Price $113.82 / $121.84 / $219.82	Professional		$113.82	$121.84	$219.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.77 / $22.46 / $34.11	Professional	26	$11.77	$22.46	$34.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $95.35 / $102.06 / $177.80	Professional	TC	$95.35	$102.06	$177.80
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $107.71 / $107.71 / $149.15	Professional		$107.71	$107.71	$149.15
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $20.10 / $20.10 / $20.10	Professional	26	$20.10	$20.10	$20.10
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $91.28 / $107.41 / $173.31	Professional		$91.28	$107.41	$173.31
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.33 / $13.36 / $28.42	Professional	26	$11.33	$13.36	$28.42
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $79.94 / $94.05 / $150.65	Professional	TC	$79.94	$94.05	$150.65
CareSource Facility/Professional Facility Modifier Low / Median / High Price $23.50 / $119.18 / $176.56	Facility		$23.50	$119.18	$176.56
CareSource Facility/Professional Professional Modifier Low / Median / High Price $23.27 / $31.22 / $185.98	Professional		$23.27	$31.22	$185.98
Cigna Facility/Professional Facility Modifier Low / Median / High Price $147.68 / $147.68 / $197.24	Facility		$147.68	$147.68	$197.24
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.75 / $26.75 / $26.75	Facility	26	$26.75	$26.75	$26.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $131.97 / $182.43 / $291.93	Professional		$131.97	$182.43	$291.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.42 / $22.29 / $37.60	Professional	26	$14.42	$22.29	$37.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $110.60 / $162.90 / $266.17	Professional	TC	$110.60	$162.90	$266.17
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $149.15	Professional		$32.34	$32.34	$149.15
United Facility/Professional Professional Modifier Low / Median / High Price $131.50 / $170.19 / $293.77	Professional		$131.50	$170.19	$293.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $22.29 / $46.32	Professional	26	$12.30	$22.29	$46.32
United Facility/Professional Professional Modifier TC Low / Median / High Price $110.23 / $150.08 / $259.29	Professional	TC	$110.23	$150.08	$259.29