Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.86 / $61.94 / $66.87	Facility	26	$12.86	$61.94	$66.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $49.24 / $61.76 / $232.80	Professional		$49.24	$61.76	$232.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.80 / $15.66 / $42.02	Professional	26	$12.80	$15.66	$42.02
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.51 / $40.14 / $103.60	Professional	TC	$33.51	$40.14	$103.60
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $40.36 / $65.00 / $111.66	Professional		$40.36	$65.00	$111.66
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $11.19 / $13.26 / $24.82	Professional	26	$11.19	$13.26	$24.82
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $52.84 / $69.40 / $145.27	Professional		$52.84	$69.40	$145.27
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.25 / $19.91 / $36.04	Professional	26	$14.25	$19.91	$36.04
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $36.81 / $52.51 / $109.66	Professional	TC	$36.81	$52.51	$109.66
CareSource Facility/Professional Professional Modifier Low / Median / High Price $15.31 / $50.01 / $91.52	Professional		$15.31	$50.01	$91.52
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 $55.08 / $86.18 / $157.63	Professional		$55.08	$86.18	$157.63
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 $38.67 / $63.66 / $116.71	Professional	TC	$38.67	$63.66	$116.71
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $66.15 / $105.46 / $513.27	Professional		$66.15	$105.46	$513.27
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $16.09 / $25.66 / $126.15	Professional	26	$16.09	$25.66	$126.15
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $50.06 / $79.81 / $366.36	Professional	TC	$50.06	$79.81	$366.36
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $20.48 / $63.66 / $104.32	Professional		$20.48	$63.66	$104.32
United Facility/Professional Professional Modifier Low / Median / High Price $54.87 / $72.38 / $128.96	Professional		$54.87	$72.38	$128.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.27 / $20.65 / $34.69	Professional	26	$15.27	$20.65	$34.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $39.60 / $52.13 / $95.59	Professional	TC	$39.60	$52.13	$95.59