Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.05 / $40.46 / $55.00	Facility	26	$16.05	$40.46	$55.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.81 / $170.24 / $302.50	Professional		$30.81	$170.24	$302.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.06 / $21.01 / $55.00	Professional	26	$9.06	$21.01	$55.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.47 / $109.78 / $234.14	Professional	TC	$17.47	$109.78	$234.14
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $19.30 / $30.93 / $41.29	Professional		$19.30	$30.93	$41.29
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.44 / $11.92 / $17.36	Professional	26	$7.44	$11.92	$17.36
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $23.39 / $23.39 / $23.39	Professional	TC	$23.39	$23.39	$23.39
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $22.44 / $38.85 / $208.40	Professional		$22.44	$38.85	$208.40
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $8.80 / $12.33 / $26.72	Professional	26	$8.80	$12.33	$26.72
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $13.12 / $22.96 / $178.40	Professional	TC	$13.12	$22.96	$178.40
CareSource Facility/Professional Professional Modifier Low / Median / High Price $9.58 / $19.61 / $32.02	Professional		$9.58	$19.61	$32.02
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.80 / $10.80 / $10.80	Facility	26	$10.80	$10.80	$10.80
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $5.59 / $5.59 / $5.59	Facility	53	$5.59	$5.59	$5.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $23.21 / $60.99 / $162.51	Professional		$23.21	$60.99	$162.51
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.57 / $15.56 / $25.51	Professional	26	$9.57	$15.56	$25.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $13.83 / $38.82 / $143.07	Professional	TC	$13.83	$38.82	$143.07
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $27.43 / $43.73 / $581.73	Professional		$27.43	$43.73	$581.73
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $15.94 / $50.96	Professional	26	$10.00	$15.94	$50.96
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $22.83 / $32.09 / $41.71	Professional	53	$22.83	$32.09	$41.71
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $17.42 / $27.78 / $581.73	Professional	TC	$17.42	$27.78	$581.73
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $12.73 / $23.59 / $43.95	Professional		$12.73	$23.59	$43.95
United Facility/Professional Professional Modifier Low / Median / High Price $23.04 / $39.88 / $176.01	Professional		$23.04	$39.88	$176.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.19 / $12.88 / $22.44	Professional	26	$9.19	$12.88	$22.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $13.32 / $23.09 / $130.72	Professional	TC	$13.32	$23.09	$130.72