Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.20 / $67.61 / $162.18	Facility	26	$30.20	$67.61	$162.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $117.49 / $323.59	Professional		$72.44	$117.49	$323.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $52.48 / $177.83	Professional	26	$28.84	$52.48	$177.83
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $72.44 / $234.42 / $776.25	Professional	50	$72.44	$234.42	$776.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $70.79 / $144.54	Professional	TC	$53.70	$70.79	$144.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $112.20 / $177.83	Professional		$77.62	$112.20	$177.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $42.66 / $74.13	Professional	26	$27.54	$42.66	$74.13
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $112.20 / $154.88 / $269.15	Professional	50	$112.20	$154.88	$269.15
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $112.20 / $194.98	Professional	TC	$112.20	$112.20	$194.98
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $128.82 / $199.53	Professional		$100.00	$128.82	$199.53
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $41.69 / $66.07	Professional	26	$36.31	$41.69	$66.07
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $151.36 / $190.55 / $295.12	Professional	50	$151.36	$190.55	$295.12
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $79.43 / $128.82	Professional	TC	$69.18	$79.43	$128.82
CareSource Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $72.44 / $125.89	Professional		$35.48	$72.44	$125.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $147.91 / $263.03	Professional		$95.50	$147.91	$263.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $51.29 / $91.20	Professional	26	$34.67	$51.29	$91.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $97.72 / $169.82	Professional	TC	$63.10	$97.72	$169.82
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $117.49 / $512.86	Professional		$102.33	$117.49	$512.86
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $38.90 / $173.78	Professional	26	$33.88	$38.90	$173.78
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $77.62 / $338.84	Professional	TC	$67.61	$77.62	$338.84
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $93.33 / $173.78	Professional		$35.48	$93.33	$173.78
United Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $134.90 / $229.09	Professional		$100.00	$134.90	$229.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $45.71 / $77.62	Professional	26	$34.67	$45.71	$77.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $87.10 / $151.36	Professional	TC	$64.57	$87.10	$151.36