Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $123.93 / $135.30 / $753.19	Facility		$123.93	$135.30	$753.19
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.86 / $38.86 / $58.51	Facility	26	$38.86	$38.86	$58.51
Aetna Facility/Professional Professional Modifier Low / Median / High Price $135.30 / $211.81 / $615.00	Professional		$135.30	$211.81	$615.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.86 / $58.51 / $213.35	Professional	26	$38.86	$58.51	$213.35
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $169.97 / $169.97 / $169.97	Professional	52	$169.97	$169.97	$169.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $96.44 / $139.72 / $196.80	Professional	TC	$96.44	$139.72	$196.80
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $112.66 / $112.66 / $155.47	Professional		$112.66	$112.66	$155.47
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $33.50 / $46.85 / $47.94	Professional	26	$33.50	$46.85	$47.94
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $76.62 / $76.62 / $101.10	Professional	TC	$76.62	$76.62	$101.10
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $445.00 / $500.00 / $556.00	Facility		$445.00	$500.00	$556.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $144.05 / $179.60 / $221.29	Professional		$144.05	$179.60	$221.29
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $41.61 / $78.15 / $118.25	Professional	26	$41.61	$78.15	$118.25
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $78.97 / $92.91 / $153.52	Professional	TC	$78.97	$92.91	$153.52
CareSource Facility/Professional Facility Modifier Low / Median / High Price $36.45 / $91.94 / $157.72	Facility		$36.45	$91.94	$157.72
CareSource Facility/Professional Professional Modifier Low / Median / High Price $39.64 / $88.11 / $157.72	Professional		$39.64	$88.11	$157.72
Cigna Facility/Professional Facility Modifier Low / Median / High Price $250.00 / $250.00 / $250.00	Facility		$250.00	$250.00	$250.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.86 / $44.86 / $44.86	Facility	26	$44.86	$44.86	$44.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $125.88 / $244.19 / $373.52	Professional		$125.88	$244.19	$373.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.38 / $72.15 / $111.06	Professional	26	$37.38	$72.15	$111.06
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $91.94 / $172.44 / $260.58	Professional	TC	$91.94	$172.44	$260.58
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $50.74 / $146.46	Professional		$32.34	$50.74	$146.46
United Facility/Professional Professional Modifier Low / Median / High Price $151.66 / $227.29 / $325.52	Professional		$151.66	$227.29	$325.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.03 / $64.45 / $96.89	Professional	26	$41.03	$64.45	$96.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.89 / $155.78 / $231.24	Professional	TC	$109.89	$155.78	$231.24