Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.75 / $61.25 / $130.72	Facility	26	$25.75	$61.25	$130.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.51 / $70.95 / $172.37	Professional		$50.51	$70.95	$172.37
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.71 / $28.10 / $65.34	Professional	26	$23.71	$28.10	$65.34
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $65.93 / $224.12 / $257.18	Professional	50	$65.93	$224.12	$257.18
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $24.95 / $28.66 / $84.76	Professional	52	$24.95	$28.66	$84.76
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.81 / $37.43 / $87.48	Professional	TC	$26.81	$37.43	$87.48
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $58.20 / $90.98 / $167.66	Professional		$58.20	$90.98	$167.66
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $25.96 / $38.45 / $69.92	Professional	26	$25.96	$38.45	$69.92
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $86.99 / $138.44 / $251.49	Professional	50	$86.99	$138.44	$251.49
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $31.70 / $52.30 / $97.92	Professional	TC	$31.70	$52.30	$97.92
CareSource Facility/Professional Professional Modifier Low / Median / High Price $64.13 / $74.05 / $138.18	Professional		$64.13	$74.05	$138.18
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.84 / $33.84 / $33.84	Facility	26	$33.84	$33.84	$33.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $66.64 / $104.89 / $175.32	Professional		$66.64	$104.89	$175.32
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.19 / $44.74 / $78.67	Professional	26	$28.19	$44.74	$78.67
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $36.59 / $61.83 / $106.84	Professional	TC	$36.59	$61.83	$106.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $65.93 / $84.66 / $242.40	Professional		$65.93	$84.66	$242.40
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $29.12 / $37.86 / $91.14	Professional	26	$29.12	$37.86	$91.14
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $60.38 / $60.38 / $84.84	Professional	52	$60.38	$60.38	$84.84
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $36.81 / $45.70 / $215.36	Professional	TC	$36.81	$45.70	$215.36
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $96.30 / $163.10 / $196.50	Professional		$96.30	$163.10	$196.50
United Facility/Professional Professional Modifier Low / Median / High Price $63.01 / $94.85 / $154.37	Professional		$63.01	$94.85	$154.37
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.63 / $36.82 / $66.11	Professional	26	$28.63	$36.82	$66.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $33.50 / $54.61 / $87.37	Professional	TC	$33.50	$54.61	$87.37