Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.99 / $52.48 / $125.89	Facility	26	$23.99	$52.48	$125.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $89.13 / $288.40	Professional		$47.86	$89.13	$288.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $38.90 / $120.23	Professional	26	$21.88	$38.90	$120.23
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $46.77 / $79.43 / $363.08	Professional	52	$46.77	$79.43	$363.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $45.71 / $104.71	Professional	TC	$25.12	$45.71	$104.71
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $47.86 / $93.33	Professional		$44.67	$47.86	$93.33
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $26.92 / $52.48	Professional	26	$18.62	$26.92	$52.48
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $38.02 / $38.02 / $38.02	Professional	52	$38.02	$38.02	$38.02
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $38.02 / $63.10	Professional	TC	$27.54	$38.02	$63.10
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $102.33 / $165.96	Professional		$69.18	$102.33	$165.96
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $36.31 / $61.66	Professional	26	$26.30	$36.31	$61.66
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $69.18 / $109.65	Professional	TC	$38.90	$69.18	$109.65
CareSource Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $35.48 / $67.61	Professional		$26.92	$35.48	$67.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $107.15 / $173.78	Professional		$66.07	$107.15	$173.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $38.02 / $66.07	Professional	26	$25.12	$38.02	$66.07
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $67.61 / $114.82	Professional	TC	$38.90	$67.61	$114.82
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $74.13 / $223.87	Professional		$61.66	$74.13	$223.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $33.88 / $81.28	Professional	26	$28.18	$33.88	$81.28
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $51.29 / $51.29 / $72.44	Professional	52	$51.29	$51.29	$72.44
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $40.74 / $213.80	Professional	TC	$33.88	$40.74	$213.80
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $54.95 / $112.20	Professional		$28.84	$54.95	$112.20
United Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $100.00 / $162.18	Professional		$67.61	$100.00	$162.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $34.67 / $60.26	Professional	26	$26.30	$34.67	$60.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $64.57 / $102.33	Professional	TC	$43.65	$64.57	$102.33