Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.27 / $13.97 / $62.42	Facility	26	$12.27	$13.97	$62.42
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $33.32 / $137.61 / $423.14	Facility	TC	$33.32	$137.61	$423.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $43.70 / $55.33 / $133.50	Professional		$43.70	$55.33	$133.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.20 / $15.33 / $35.76	Professional	26	$12.20	$15.33	$35.76
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $76.55 / $99.21 / $232.86	Professional	50	$76.55	$99.21	$232.86
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.75 / $34.58 / $86.44	Professional	TC	$30.75	$34.58	$86.44
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $40.13 / $53.81 / $97.21	Professional		$40.13	$53.81	$97.21
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $11.20 / $19.10 / $25.29	Professional	26	$11.20	$19.10	$25.29
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $31.18 / $65.87 / $68.56	Professional	TC	$31.18	$65.87	$68.56
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $45.67 / $60.42 / $126.98	Professional		$45.67	$60.42	$126.98
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $13.50 / $18.61 / $34.08	Professional	26	$13.50	$18.61	$34.08
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $68.43 / $90.63 / $190.80	Professional	50	$68.43	$90.63	$190.80
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $30.68 / $44.71 / $93.34	Professional	TC	$30.68	$44.71	$93.34
CareSource Facility/Professional Professional Modifier Low / Median / High Price $14.39 / $42.56 / $77.93	Professional		$14.39	$42.56	$77.93
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.14 / $16.14 / $16.14	Facility	26	$16.14	$16.14	$16.14
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $44.74 / $44.74 / $44.74	Facility	TC	$44.74	$44.74	$44.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $47.47 / $75.27 / $136.61	Professional		$47.47	$75.27	$136.61
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.68 / $23.08 / $39.36	Professional	26	$14.68	$23.08	$39.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $32.42 / $53.17 / $98.04	Professional	TC	$32.42	$53.17	$98.04
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $57.60 / $91.82 / $314.00	Professional		$57.60	$91.82	$314.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $14.98 / $23.88 / $97.34	Professional	26	$14.98	$23.88	$97.34
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $42.61 / $67.93 / $216.66	Professional	TC	$42.61	$67.93	$216.66
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $19.21 / $55.30 / $89.77	Professional		$19.21	$55.30	$89.77
United Facility/Professional Professional Modifier Low / Median / High Price $47.20 / $64.23 / $115.38	Professional		$47.20	$64.23	$115.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.26 / $18.67 / $32.29	Professional	26	$14.26	$18.67	$32.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $32.94 / $42.96 / $82.15	Professional	TC	$32.94	$42.96	$82.15