Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.30 / $57.54 / $141.25	Facility	26	$26.30	$57.54	$141.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $97.72 / $380.19	Professional		$50.12	$97.72	$380.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $41.69 / $134.90	Professional	26	$23.99	$41.69	$134.90
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $60.26 / $138.04 / $138.04	Professional	50	$60.26	$138.04	$138.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $10.00 / $28.84 / $97.72	Professional	TC	$10.00	$28.84	$97.72
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $46.77 / $91.20	Professional		$39.81	$46.77	$91.20
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $61.66 / $134.90	Professional	26	$33.11	$61.66	$134.90
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $8.91 / $8.91 / $8.91	Professional	TC	$8.91	$8.91	$8.91
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $123.03 / $194.98	Professional		$69.18	$123.03	$194.98
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $38.90 / $67.61	Professional	26	$28.84	$38.90	$67.61
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $102.33 / $186.21 / $295.12	Professional	50	$102.33	$186.21	$295.12
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $83.18 / $138.04	Professional	TC	$15.14	$83.18	$138.04
CareSource Facility/Professional Professional Modifier Low / Median / High Price $10.00 / $47.86 / $69.18	Professional		$10.00	$47.86	$69.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $131.83 / $229.09	Professional		$67.61	$131.83	$229.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $44.67 / $91.20	Professional	26	$30.90	$44.67	$91.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $14.45 / $91.20 / $162.18	Professional	TC	$14.45	$91.20	$162.18
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $63.10 / $354.81	Professional		$54.95	$63.10	$354.81
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $50.12 / $114.82	Professional	26	$43.65	$50.12	$114.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $11.22 / $12.88 / $263.03	Professional	TC	$11.22	$12.88	$263.03
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $11.48 / $52.48 / $112.20	Professional		$11.48	$52.48	$112.20
United Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $125.89 / $190.55	Professional		$67.61	$125.89	$190.55
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $39.81 / $74.13	Professional	26	$30.90	$39.81	$74.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $77.62 / $138.04	Professional	TC	$21.38	$77.62	$138.04