Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.30 / $29.51 / $66.07	Facility	26	$12.30	$29.51	$66.07
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $33.11 / $102.33 / $426.58	Facility	TC	$33.11	$102.33	$426.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $64.57 / $181.97	Professional		$41.69	$64.57	$181.97
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $19.05 / $47.86	Professional	26	$12.02	$19.05	$47.86
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $29.51 / $100.00 / $269.15	Professional	50	$29.51	$100.00	$269.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $40.74 / $91.20	Professional	TC	$28.84	$40.74	$91.20
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $69.18 / $97.72	Professional		$36.31	$69.18	$97.72
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $16.22 / $25.12	Professional	26	$11.22	$16.22	$25.12
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $38.90 / $79.43	Professional	TC	$28.18	$38.90	$79.43
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $60.26 / $95.50	Professional		$44.67	$60.26	$95.50
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $18.62 / $28.18	Professional	26	$14.79	$18.62	$28.18
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $67.61 / $89.13 / $141.25	Professional	50	$67.61	$89.13	$141.25
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $40.74 / $67.61	Professional	TC	$30.90	$40.74	$67.61
CareSource Facility/Professional Professional Modifier Low / Median / High Price $14.45 / $42.66 / $66.07	Professional		$14.45	$42.66	$66.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $69.18 / $128.82	Professional		$43.65	$69.18	$128.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $21.38 / $38.02	Professional	26	$12.30	$21.38	$38.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $48.98 / $95.50	Professional	TC	$31.62	$48.98	$95.50
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $72.44 / $239.88	Professional		$54.95	$72.44	$239.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $18.62 / $74.13	Professional	26	$14.13	$18.62	$74.13
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $53.70 / $165.96	Professional	TC	$40.74	$53.70	$165.96
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $15.14 / $51.29 / $89.13	Professional		$15.14	$51.29	$89.13
United Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $58.88 / $112.20	Professional		$46.77	$58.88	$112.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $17.78 / $31.62	Professional	26	$13.49	$17.78	$31.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $41.69 / $79.43	Professional	TC	$33.11	$41.69	$79.43