Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.12 / $43.65 / $128.82	Facility	26	$25.12	$43.65	$128.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $69.18 / $199.53	Professional		$45.71	$69.18	$199.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $48.98 / $107.15	Professional	26	$25.12	$48.98	$107.15
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $14.13 / $50.12 / $177.83	Professional	52	$14.13	$50.12	$177.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $28.18 / $63.10	Professional	TC	$19.05	$28.18	$63.10
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $43.65 / $87.10	Professional		$37.15	$43.65	$87.10
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $29.51 / $48.98	Professional	26	$21.88	$29.51	$48.98
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $10.96 / $34.67 / $87.10	Professional	52	$10.96	$34.67	$87.10
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $20.42 / $31.62	Professional	TC	$15.85	$20.42	$31.62
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $64.57 / $104.71	Professional		$52.48	$64.57	$104.71
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $35.48 / $56.23	Professional	26	$28.84	$35.48	$56.23
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $28.18 / $46.77	Professional	TC	$23.44	$28.18	$46.77
CareSource Facility/Professional Professional Modifier Low / Median / High Price $23.44 / $33.11 / $64.57	Professional		$23.44	$33.11	$64.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $77.62 / $134.90	Professional		$45.71	$77.62	$134.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $42.66 / $75.86	Professional	26	$24.55	$42.66	$75.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $35.48 / $60.26	Professional	TC	$21.38	$35.48	$60.26
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $63.10 / $186.21	Professional		$51.29	$63.10	$186.21
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $36.31 / $102.33	Professional	26	$28.18	$36.31	$102.33
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $46.77 / $46.77 / $66.07	Professional	52	$46.77	$46.77	$66.07
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $29.51 / $85.11	Professional	TC	$23.99	$29.51	$85.11
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $23.44 / $45.71 / $85.11	Professional		$23.44	$45.71	$85.11
United Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $70.79 / $117.49	Professional		$50.12	$70.79	$117.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $38.90 / $64.57	Professional	26	$28.18	$38.90	$64.57
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $32.36 / $53.70	Professional	TC	$22.91	$32.36	$53.70