Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.01 / $39.54 / $132.25	Facility	26	$26.01	$39.54	$132.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.34 / $93.69 / $257.49	Professional		$50.34	$93.69	$257.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.78 / $34.82 / $82.14	Professional	26	$24.78	$34.82	$82.14
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $139.50 / $139.50 / $139.50	Professional	50	$139.50	$139.50	$139.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.29 / $31.85 / $174.30	Professional	TC	$18.29	$31.85	$174.30
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $41.52 / $64.34 / $96.36	Professional		$41.52	$64.34	$96.36
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $31.90 / $67.06 / $133.52	Professional	26	$31.90	$67.06	$133.52
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $18.16 / $18.16 / $18.16	Professional	TC	$18.16	$18.16	$18.16
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $51.90 / $109.88 / $195.28	Professional		$51.90	$109.88	$195.28
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $29.43 / $45.41 / $88.28	Professional	26	$29.43	$45.41	$88.28
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $77.84 / $165.73 / $292.92	Professional	50	$77.84	$165.73	$292.92
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $10.60 / $54.74 / $128.82	Professional	TC	$10.60	$54.74	$128.82
CareSource Facility/Professional Professional Modifier Low / Median / High Price $10.00 / $45.93 / $73.92	Professional		$10.00	$45.93	$73.92
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.32 / $49.32 / $49.32	Facility	26	$49.32	$49.32	$49.32
Cigna Facility/Professional Professional Modifier Low / Median / High Price $76.53 / $132.63 / $245.58	Professional		$76.53	$132.63	$245.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.13 / $47.66 / $90.41	Professional	26	$31.13	$47.66	$90.41
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.75 / $87.63 / $173.56	Professional	TC	$16.75	$87.63	$173.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $51.90 / $64.34 / $415.00	Professional		$51.90	$64.34	$415.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $41.54 / $52.36 / $120.00	Professional	26	$41.54	$52.36	$120.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $10.36 / $12.43 / $301.01	Professional	TC	$10.36	$12.43	$301.01
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $11.26 / $50.52 / $95.63	Professional		$11.26	$50.52	$95.63
United Facility/Professional Professional Modifier Low / Median / High Price $72.59 / $131.32 / $193.14	Professional		$72.59	$131.32	$193.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.95 / $39.49 / $82.49	Professional	26	$30.95	$39.49	$82.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.54 / $74.91 / $139.25	Professional	TC	$24.54	$74.91	$139.25