Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.00 / $99.61 / $789.00	Facility	26	$85.00	$99.61	$789.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $158.13 / $425.00 / $938.01	Professional		$158.13	$425.00	$938.01
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.83 / $117.27 / $309.10	Professional	26	$63.83	$117.27	$309.10
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $1,908.64 / $1,908.64 / $1,908.64	Professional	50	$1,908.64	$1,908.64	$1,908.64
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $123.88 / $212.50 / $485.32	Professional	52	$123.88	$212.50	$485.32
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $154.29 / $340.00 / $695.54	Professional	TC	$154.29	$340.00	$695.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $134.87 / $178.91 / $316.35	Professional		$134.87	$178.91	$316.35
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $50.01 / $78.17 / $114.85	Professional	26	$50.01	$78.17	$114.85
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $126.60 / $238.71 / $238.71	Professional	TC	$126.60	$238.71	$238.71
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $200.78 / $376.65 / $745.94	Professional		$200.78	$376.65	$745.94
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $60.05 / $84.37 / $174.04	Professional	26	$60.05	$84.37	$174.04
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $299.16 / $559.87 / $1,121.73	Professional	50	$299.16	$559.87	$1,121.73
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $139.25 / $237.30 / $602.65	Professional	TC	$139.25	$237.30	$602.65
CareSource Facility/Professional Professional Modifier Low / Median / High Price $65.47 / $152.16 / $278.38	Professional		$65.47	$152.16	$278.38
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $73.64 / $73.64 / $73.64	Facility	26	$73.64	$73.64	$73.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $233.12 / $530.00 / $965.00	Professional		$233.12	$530.00	$965.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.68 / $112.98 / $194.00	Professional	26	$61.68	$112.98	$194.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $164.76 / $401.80 / $817.58	Professional	TC	$164.76	$401.80	$817.58
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $220.51 / $400.92 / $1,395.32	Professional		$220.51	$400.92	$1,395.32
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $68.18 / $108.69 / $239.79	Professional	26	$68.18	$108.69	$239.79
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $183.58 / $183.58 / $257.97	Professional	52	$183.58	$183.58	$257.97
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $152.33 / $276.95 / $1,307.91	Professional	TC	$152.33	$276.95	$1,307.91
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $89.53 / $209.10 / $374.60	Professional		$89.53	$209.10	$374.60
United Facility/Professional Professional Modifier Low / Median / High Price $218.28 / $396.95 / $804.99	Professional		$218.28	$396.95	$804.99
United Facility/Professional Professional Modifier 26 Low / Median / High Price $61.23 / $86.08 / $161.49	Professional	26	$61.23	$86.08	$161.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $151.38 / $273.04 / $641.29	Professional	TC	$151.38	$273.04	$641.29