Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.00 / $66.93 / $210.99	Facility	26	$55.00	$66.93	$210.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $49.54 / $245.40 / $499.34	Professional		$49.54	$245.40	$499.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.08 / $60.50 / $182.00	Professional	26	$45.08	$60.50	$182.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $964.54 / $964.54 / $964.54	Professional	50	$964.54	$964.54	$964.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $113.47 / $220.00 / $389.69	Professional	TC	$113.47	$220.00	$389.69
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $98.32 / $117.46 / $196.97	Professional		$98.32	$117.46	$196.97
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $36.72 / $59.51 / $84.33	Professional	26	$36.72	$59.51	$84.33
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $115.06 / $141.56 / $141.56	Professional	TC	$115.06	$141.56	$141.56
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $131.72 / $237.25 / $431.94	Professional		$131.72	$237.25	$431.94
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $45.42 / $66.04 / $131.56	Professional	26	$45.42	$66.04	$131.56
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $194.32 / $357.72 / $647.91	Professional	50	$194.32	$357.72	$647.91
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $83.66 / $157.68 / $314.80	Professional	TC	$83.66	$157.68	$314.80
CareSource Facility/Professional Professional Modifier Low / Median / High Price $48.08 / $102.01 / $165.20	Professional		$48.08	$102.01	$165.20
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 $167.75 / $306.00 / $517.76	Professional		$167.75	$306.00	$517.76
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 $117.80 / $208.90 / $391.24	Professional	TC	$117.80	$208.90	$391.24
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $140.46 / $255.38 / $706.68	Professional		$140.46	$255.38	$706.68
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 $90.51 / $164.56 / $659.00	Professional	TC	$90.51	$164.56	$659.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $64.88 / $120.76 / $236.23	Professional		$64.88	$120.76	$236.23
United Facility/Professional Professional Modifier Low / Median / High Price $141.62 / $254.17 / $441.15	Professional		$141.62	$254.17	$441.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.21 / $66.00 / $112.12	Professional	26	$47.21	$66.00	$112.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $98.47 / $182.41 / $316.29	Professional	TC	$98.47	$182.41	$316.29