Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.85 / $26.11 / $102.55	Facility	26	$19.85	$26.11	$102.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $31.84 / $66.43 / $170.25	Professional		$31.84	$66.43	$170.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.35 / $36.26 / $83.62	Professional	26	$18.35	$36.26	$83.62
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $106.53 / $106.53 / $110.59	Professional	50	$106.53	$106.53	$110.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $9.77 / $28.35 / $68.38	Professional	TC	$9.77	$28.35	$68.38
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $51.88 / $96.00 / $116.07	Professional		$51.88	$96.00	$116.07
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $24.42 / $46.38 / $60.81	Professional	26	$24.42	$46.38	$60.81
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $10.34 / $28.02 / $56.00	Professional	TC	$10.34	$28.02	$56.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $61.96 / $143.58	Professional		$36.31	$61.96	$143.58
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $21.54 / $34.46 / $67.00	Professional	26	$21.54	$34.46	$67.00
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $56.95 / $92.94 / $215.37	Professional	50	$56.95	$92.94	$215.37
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $11.44 / $32.06 / $67.04	Professional	TC	$11.44	$32.06	$67.04
CareSource Facility/Professional Professional Modifier Low / Median / High Price $30.40 / $43.13 / $81.15	Professional		$30.40	$43.13	$81.15
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.43 / $37.43 / $37.43	Facility	26	$37.43	$37.43	$37.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.19 / $61.94 / $131.75	Professional		$34.19	$61.94	$131.75
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.46 / $35.63 / $70.38	Professional	26	$22.46	$35.63	$70.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $11.45 / $23.28 / $64.29	Professional	TC	$11.45	$23.28	$64.29
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $62.52 / $75.56 / $207.00	Professional		$62.52	$75.56	$207.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $31.84 / $40.20 / $136.62	Professional	26	$31.84	$40.20	$136.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $30.68 / $35.36 / $80.27	Professional	TC	$30.68	$35.36	$80.27
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $29.49 / $52.22 / $106.49	Professional		$29.49	$52.22	$106.49
United Facility/Professional Professional Modifier Low / Median / High Price $37.70 / $58.10 / $124.00	Professional		$37.70	$58.10	$124.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.23 / $29.87 / $62.61	Professional	26	$23.23	$29.87	$62.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $11.89 / $30.96 / $68.94	Professional	TC	$11.89	$30.96	$68.94