Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $5.83 / $9.96 / $467.00	Facility	26	$5.83	$9.96	$467.00
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $26.01 / $118.70 / $429.25	Facility	TC	$26.01	$118.70	$429.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $17.16 / $38.20 / $127.70	Professional		$17.16	$38.20	$127.70
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.83 / $10.86 / $31.26	Professional	26	$5.83	$10.86	$31.26
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $34.65 / $96.73 / $182.30	Professional	50	$34.65	$96.73	$182.30
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $13.59 / $15.92 / $34.22	Professional	52	$13.59	$15.92	$34.22
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.57 / $29.89 / $66.98	Professional	TC	$22.57	$29.89	$66.98
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $28.45 / $48.33 / $63.97	Professional		$28.45	$48.33	$63.97
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.17 / $8.48 / $12.42	Professional	26	$5.17	$8.48	$12.42
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $67.81 / $67.81 / $67.81	Professional	50	$67.81	$67.81	$67.81
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $35.36 / $45.53 / $102.38	Professional	TC	$35.36	$45.53	$102.38
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $26.34 / $42.90 / $88.57	Professional		$26.34	$42.90	$88.57
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $6.13 / $9.10 / $17.85	Professional	26	$6.13	$9.10	$17.85
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $39.52 / $64.36 / $133.27	Professional	50	$39.52	$64.36	$133.27
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $20.87 / $33.54 / $71.31	Professional	TC	$20.87	$33.54	$71.31
CareSource Facility/Professional Professional Modifier Low / Median / High Price $6.77 / $33.15 / $56.56	Professional		$6.77	$33.15	$56.56
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.66 / $7.66 / $7.66	Facility	26	$7.66	$7.66	$7.66
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $35.40 / $35.40 / $35.40	Facility	TC	$35.40	$35.40	$35.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $27.10 / $46.80 / $92.84	Professional		$27.10	$46.80	$92.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.14 / $10.72 / $18.07	Professional	26	$6.14	$10.72	$18.07
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.55 / $36.46 / $75.16	Professional	TC	$19.55	$36.46	$75.16
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $40.90 / $55.77 / $136.72	Professional		$40.90	$55.77	$136.72
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $7.15 / $11.40 / $24.59	Professional	26	$7.15	$11.40	$24.59
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $34.04 / $34.04 / $47.86	Professional	52	$34.04	$34.04	$47.86
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $33.75 / $53.80 / $112.79	Professional	TC	$33.75	$53.80	$112.79
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $8.78 / $38.63 / $66.65	Professional		$8.78	$38.63	$66.65
United Facility/Professional Professional Modifier Low / Median / High Price $27.07 / $40.18 / $79.03	Professional		$27.07	$40.18	$79.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.06 / $8.58 / $15.37	Professional	26	$6.06	$8.58	$15.37
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.85 / $32.56 / $64.37	Professional	TC	$20.85	$32.56	$64.37