Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.91 / $37.38 / $121.83	Facility	26	$23.91	$37.38	$121.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.01 / $88.15 / $196.76	Professional		$50.01	$88.15	$196.76
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.41 / $28.69 / $75.09	Professional	26	$22.41	$28.69	$75.09
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $23.77 / $30.99 / $106.00	Professional	52	$23.77	$30.99	$106.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.32 / $39.97 / $134.24	Professional	TC	$26.32	$39.97	$134.24
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $43.79 / $70.52 / $94.16	Professional		$43.79	$70.52	$94.16
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $11.20 / $39.68 / $50.25	Professional	26	$11.20	$39.68	$50.25
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $10.95 / $38.31 / $57.96	Professional	52	$10.95	$38.31	$57.96
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $56.28 / $93.96 / $161.54	Professional		$56.28	$93.96	$161.54
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $24.19 / $35.29 / $63.69	Professional	26	$24.19	$35.29	$63.69
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $29.75 / $59.24 / $100.69	Professional	TC	$29.75	$59.24	$100.69
CareSource Facility/Professional Professional Modifier Low / Median / High Price $26.39 / $37.21 / $72.97	Professional		$26.39	$37.21	$72.97
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.97 / $30.97 / $30.97	Facility	26	$30.97	$30.97	$30.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $71.58 / $113.40 / $176.35	Professional		$71.58	$113.40	$176.35
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.81 / $39.15 / $69.15	Professional	26	$25.81	$39.15	$69.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $41.68 / $71.97 / $116.16	Professional	TC	$41.68	$71.97	$116.16
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $56.34 / $73.14 / $224.54	Professional		$56.34	$73.14	$224.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $26.31 / $34.20 / $79.08	Professional	26	$26.31	$34.20	$79.08
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $51.59 / $51.59 / $72.50	Professional	52	$51.59	$51.59	$72.50
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $30.03 / $37.29 / $211.76	Professional	TC	$30.03	$37.29	$211.76
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $27.32 / $50.81 / $107.82	Professional		$27.32	$50.81	$107.82
United Facility/Professional Professional Modifier Low / Median / High Price $75.52 / $102.15 / $171.34	Professional		$75.52	$102.15	$171.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.57 / $34.76 / $64.86	Professional	26	$26.57	$34.76	$64.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $44.18 / $67.39 / $104.59	Professional	TC	$44.18	$67.39	$104.59