Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.85 / $14.66 / $68.34	Facility	26	$12.85	$14.66	$68.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $56.75 / $71.56 / $192.72	Professional		$56.75	$71.56	$192.72
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.81 / $20.28 / $66.40	Professional	26	$12.81	$20.28	$66.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.39 / $48.54 / $119.66	Professional	TC	$42.39	$48.54	$119.66
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $52.22 / $91.40 / $117.79	Professional		$52.22	$91.40	$117.79
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $12.43 / $21.27 / $29.85	Professional	26	$12.43	$21.27	$29.85
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $192.91 / $192.91 / $192.91	Professional	TC	$192.91	$192.91	$192.91
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $58.17 / $78.70 / $165.69	Professional		$58.17	$78.70	$165.69
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.51 / $19.82 / $35.71	Professional	26	$14.51	$19.82	$35.71
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $41.98 / $61.83 / $129.08	Professional	TC	$41.98	$61.83	$129.08
CareSource Facility/Professional Professional Modifier Low / Median / High Price $15.31 / $58.88 / $104.07	Professional		$15.31	$58.88	$104.07
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.32 / $17.32 / $17.32	Facility	26	$17.32	$17.32	$17.32
Cigna Facility/Professional Professional Modifier Low / Median / High Price $58.18 / $94.61 / $178.30	Professional		$58.18	$94.61	$178.30
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.70 / $24.69 / $42.15	Professional	26	$15.70	$24.69	$42.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $44.53 / $74.23 / $137.02	Professional	TC	$44.53	$74.23	$137.02
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $75.02 / $119.60 / $371.00	Professional		$75.02	$119.60	$371.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $16.09 / $25.66 / $96.46	Professional	26	$16.09	$25.66	$96.46
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $58.94 / $93.96 / $274.54	Professional	TC	$58.94	$93.96	$274.54
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $19.84 / $70.63 / $119.76	Professional		$19.84	$70.63	$119.76
United Facility/Professional Professional Modifier Low / Median / High Price $60.49 / $82.18 / $146.25	Professional		$60.49	$82.18	$146.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.27 / $19.96 / $35.36	Professional	26	$15.27	$19.96	$35.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $45.22 / $62.36 / $111.88	Professional	TC	$45.22	$62.36	$111.88