Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.00 / $74.48 / $210.99	Facility	26	$55.00	$74.48	$210.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $86.45 / $260.51 / $499.34	Professional		$86.45	$260.51	$499.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.78 / $67.11 / $182.03	Professional	26	$46.78	$67.11	$182.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $119.70 / $220.00 / $428.37	Professional	TC	$119.70	$220.00	$428.37
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $110.57 / $128.44 / $281.45	Professional		$110.57	$128.44	$281.45
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $36.72 / $63.92 / $84.33	Professional	26	$36.72	$63.92	$84.33
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $195.32 / $195.32 / $195.32	Professional	TC	$195.32	$195.32	$195.32
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $154.02 / $252.72 / $480.18	Professional		$154.02	$252.72	$480.18
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $45.42 / $66.04 / $130.22	Professional	26	$45.42	$66.04	$130.22
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $230.71 / $384.60 / $720.27	Professional	50	$230.71	$384.60	$720.27
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $110.49 / $171.58 / $357.47	Professional	TC	$110.49	$171.58	$357.47
CareSource Facility/Professional Professional Modifier Low / Median / High Price $48.08 / $123.79 / $226.33	Professional		$48.08	$123.79	$226.33
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.02 / $54.02 / $54.02	Facility	26	$54.02	$54.02	$54.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $176.65 / $328.29 / $539.53	Professional		$176.65	$328.29	$539.53
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.33 / $82.27 / $141.28	Professional	26	$48.33	$82.27	$141.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $128.80 / $233.08 / $415.68	Professional	TC	$128.80	$233.08	$415.68
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $173.86 / $316.10 / $705.72	Professional		$173.86	$316.10	$705.72
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $49.96 / $79.65 / $175.82	Professional	26	$49.96	$79.65	$175.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $123.90 / $225.28 / $659.00	Professional	TC	$123.90	$225.28	$659.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $63.77 / $153.35 / $273.73	Professional		$63.77	$153.35	$273.73
United Facility/Professional Professional Modifier Low / Median / High Price $173.88 / $260.02 / $461.43	Professional		$173.88	$260.02	$461.43
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.60 / $66.18 / $112.33	Professional	26	$46.60	$66.18	$112.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $123.53 / $193.06 / $345.61	Professional	TC	$123.53	$193.06	$345.61