Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.35 / $13.95 / $47.54	Facility	26	$9.35	$13.95	$47.54
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $29.81 / $120.43 / $491.28	Facility	TC	$29.81	$120.43	$491.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.37 / $49.90 / $166.90	Professional		$25.37	$49.90	$166.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.39 / $19.05 / $51.00	Professional	26	$9.39	$19.05	$51.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $41.42 / $85.76 / $268.66	Professional	50	$41.42	$85.76	$268.66
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $16.80 / $19.57 / $47.37	Professional	52	$16.80	$19.57	$47.37
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.50 / $34.14 / $79.09	Professional	TC	$27.50	$34.14	$79.09
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $35.15 / $74.00 / $79.36	Professional		$35.15	$74.00	$79.36
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.78 / $14.99 / $19.88	Professional	26	$8.78	$14.99	$19.88
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $117.08 / $117.08 / $117.08	Professional	50	$117.08	$117.08	$117.08
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $35.22 / $52.96 / $110.26	Professional		$35.22	$52.96	$110.26
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.11 / $14.60 / $28.57	Professional	26	$10.11	$14.60	$28.57
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $52.83 / $79.44 / $165.88	Professional	50	$52.83	$79.44	$165.88
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $25.16 / $40.61 / $82.30	Professional	TC	$25.16	$40.61	$82.30
CareSource Facility/Professional Professional Modifier Low / Median / High Price $11.28 / $38.65 / $70.09	Professional		$11.28	$38.65	$70.09
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.66 / $12.66 / $12.66	Facility	26	$12.66	$12.66	$12.66
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $40.63 / $40.63 / $40.63	Facility	TC	$40.63	$40.63	$40.63
Cigna Facility/Professional Professional Modifier Low / Median / High Price $37.00 / $62.99 / $117.18	Professional		$37.00	$62.99	$117.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $17.85 / $29.75	Professional	26	$10.23	$17.85	$29.75
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.91 / $46.58 / $86.23	Professional	TC	$25.91	$46.58	$86.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $50.49 / $80.48 / $168.78	Professional		$50.49	$80.48	$168.78
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $11.78 / $18.78 / $39.38	Professional	26	$11.78	$18.78	$39.38
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $42.04 / $42.04 / $59.07	Professional	52	$42.04	$42.04	$59.07
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $38.71 / $61.71 / $129.41	Professional	TC	$38.71	$61.71	$129.41
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $13.92 / $47.78 / $82.43	Professional		$13.92	$47.78	$82.43
United Facility/Professional Professional Modifier Low / Median / High Price $38.42 / $53.30 / $96.31	Professional		$38.42	$53.30	$96.31
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.93 / $14.05 / $23.10	Professional	26	$9.93	$14.05	$23.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.73 / $39.33 / $71.90	Professional	TC	$27.73	$39.33	$71.90