Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $36.31 / $104.71	Facility	26	$19.95	$36.31	$104.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $74.13 / $223.87	Professional		$36.31	$74.13	$223.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $48.98 / $162.18	Professional	26	$19.05	$48.98	$162.18
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $46.77 / $72.44 / $234.42	Professional	50	$46.77	$72.44	$234.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $8.91 / $28.18 / $74.13	Professional	TC	$8.91	$28.18	$74.13
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $57.54 / $109.65	Professional		$43.65	$57.54	$109.65
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $30.90 / $58.88	Professional	26	$24.55	$30.90	$58.88
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $79.43 / $79.43 / $79.43	Professional	50	$79.43	$79.43	$79.43
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $26.92 / $41.69	Professional	TC	$19.50	$26.92	$41.69
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $52.48 / $91.20	Professional		$32.36	$52.48	$91.20
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $28.18 / $50.12	Professional	26	$19.95	$28.18	$50.12
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $47.86 / $77.62 / $138.04	Professional	50	$47.86	$77.62	$138.04
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $10.47 / $19.05 / $43.65	Professional	TC	$10.47	$19.05	$43.65
CareSource Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $39.81 / $74.13	Professional		$29.51	$39.81	$74.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $57.54 / $128.82	Professional		$33.11	$57.54	$128.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $33.11 / $70.79	Professional	26	$22.39	$33.11	$70.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $10.96 / $20.89 / $66.07	Professional	TC	$10.96	$20.89	$66.07
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $74.13 / $213.80	Professional		$64.57	$74.13	$213.80
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $37.15 / $141.25	Professional	26	$32.36	$37.15	$141.25
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $37.15 / $85.11	Professional	TC	$32.36	$37.15	$85.11
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $57.54 / $109.65	Professional		$31.62	$57.54	$109.65
United Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $57.54 / $123.03	Professional		$36.31	$57.54	$123.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $28.84 / $56.23	Professional	26	$22.91	$28.84	$56.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $12.02 / $30.20 / $66.07	Professional	TC	$12.02	$30.20	$66.07