Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.05 / $34.35 / $153.06	Facility	26	$30.05	$34.35	$153.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $78.98 / $109.40 / $259.91	Professional		$78.98	$109.40	$259.91
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.64 / $36.07 / $88.71	Professional	26	$29.64	$36.07	$88.71
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $90.59 / $265.25 / $778.50	Professional	50	$90.59	$265.25	$778.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $55.11 / $70.84 / $154.06	Professional	TC	$55.11	$70.84	$154.06
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $79.17 / $168.12 / $183.75	Professional		$79.17	$168.12	$183.75
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $27.97 / $45.97 / $81.81	Professional	26	$27.97	$45.97	$81.81
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $114.37 / $196.95 / $275.62	Professional	50	$114.37	$196.95	$275.62
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $112.65 / $112.65 / $112.65	Professional	TC	$112.65	$112.65	$112.65
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $89.07 / $132.02 / $239.99	Professional		$89.07	$132.02	$239.99
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $30.42 / $41.23 / $80.61	Professional	26	$30.42	$41.23	$80.61
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $133.60 / $197.08 / $359.98	Professional	50	$133.60	$197.08	$359.98
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $58.67 / $79.78 / $159.38	Professional	TC	$58.67	$79.78	$159.38
CareSource Facility/Professional Professional Modifier Low / Median / High Price $34.72 / $74.50 / $130.94	Professional		$34.72	$74.50	$130.94
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.72 / $39.72 / $39.72	Facility	26	$39.72	$39.72	$39.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $103.35 / $154.38 / $269.73	Professional		$103.35	$154.38	$269.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.33 / $52.48 / $92.87	Professional	26	$36.33	$52.48	$92.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $67.23 / $101.10 / $177.77	Professional	TC	$67.23	$101.10	$177.77
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $98.97 / $118.76 / $455.00	Professional		$98.97	$118.76	$455.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $33.78 / $42.61 / $154.69	Professional	26	$33.78	$42.61	$154.69
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $65.19 / $78.23 / $300.30	Professional	TC	$65.19	$78.23	$300.30
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $43.00 / $93.11 / $166.39	Professional		$43.00	$93.11	$166.39
United Facility/Professional Professional Modifier Low / Median / High Price $99.96 / $139.24 / $231.92	Professional		$99.96	$139.24	$231.92
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.77 / $47.44 / $79.18	Professional	26	$35.77	$47.44	$79.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $63.78 / $89.35 / $152.74	Professional	TC	$63.78	$89.35	$152.74