Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.95 / $91.20 / $218.78	Facility	26	$54.95	$91.20	$218.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $186.21 / $549.54	Professional		$54.95	$186.21	$549.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $81.28 / $199.53	Professional	26	$45.71	$81.28	$199.53
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $354.81 / $354.81 / $354.81	Professional	50	$354.81	$354.81	$354.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $199.53 / $371.54	Professional	TC	$102.33	$199.53	$371.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $141.25 / $204.17	Professional		$104.71	$141.25	$204.17
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $54.95 / $85.11	Professional	26	$35.48	$54.95	$85.11
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $147.91 / $162.18	Professional	TC	$97.72	$147.91	$162.18
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $269.15 / $446.68	Professional		$177.83	$269.15	$446.68
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $70.79 / $107.15	Professional	26	$50.12	$70.79	$107.15
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $269.15 / $407.38 / $676.08	Professional	50	$269.15	$407.38	$676.08
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $194.98 / $331.13	Professional	TC	$120.23	$194.98	$331.13
CareSource Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $123.03 / $199.53	Professional		$47.86	$123.03	$199.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $309.03 / $512.86	Professional		$165.96	$309.03	$512.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $74.13 / $128.82	Professional	26	$43.65	$74.13	$128.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $213.80 / $380.19	Professional	TC	$125.89	$213.80	$380.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $213.80 / $660.69	Professional		$162.18	$213.80	$660.69
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $63.10 / $165.96	Professional	26	$46.77	$63.10	$165.96
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $151.36 / $660.69	Professional	TC	$117.49	$151.36	$660.69
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $125.89 / $275.42	Professional		$48.98	$125.89	$275.42
United Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $257.04 / $457.09	Professional		$165.96	$257.04	$457.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $61.66 / $112.20	Professional	26	$45.71	$61.66	$112.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $186.21 / $331.13	Professional	TC	$117.49	$186.21	$331.13