Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.07 / $28.64 / $126.32	Facility	26	$25.07	$28.64	$126.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $45.50 / $57.66 / $148.29	Professional		$45.50	$57.66	$148.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.08 / $43.49 / $93.51	Professional	26	$25.08	$43.49	$93.51
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $14.15 / $56.77 / $285.00	Professional	52	$14.15	$56.77	$285.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.27 / $25.32 / $65.69	Professional	TC	$19.27	$25.32	$65.69
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $40.25 / $68.66 / $94.35	Professional		$40.25	$68.66	$94.35
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $23.22 / $40.17 / $52.72	Professional	26	$23.22	$40.17	$52.72
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $9.47 / $9.88 / $34.59	Professional	52	$9.47	$9.88	$34.59
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $19.64 / $21.26 / $21.26	Professional	TC	$19.64	$21.26	$21.26
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $50.09 / $67.33 / $121.65	Professional		$50.09	$67.33	$121.65
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $27.05 / $36.76 / $65.70	Professional	26	$27.05	$36.76	$65.70
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $30.58 / $55.94	Professional	TC	$22.91	$30.58	$55.94
CareSource Facility/Professional Professional Modifier Low / Median / High Price $23.22 / $37.40 / $66.20	Professional		$23.22	$37.40	$66.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.40 / $32.40 / $32.40	Facility	26	$32.40	$32.40	$32.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $50.51 / $82.34 / $141.27	Professional		$50.51	$82.34	$141.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.02 / $45.72 / $78.31	Professional	26	$29.02	$45.72	$78.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.58 / $37.69 / $64.52	Professional	TC	$23.58	$37.69	$64.52
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $27.58 / $66.06 / $193.62	Professional		$27.58	$66.06	$193.62
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $27.58 / $39.74 / $105.78	Professional	26	$27.58	$39.74	$105.78
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $46.54 / $46.54 / $65.40	Professional	52	$46.54	$46.54	$65.40
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $25.54 / $33.44 / $87.84	Professional	TC	$25.54	$33.44	$87.84
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $28.12 / $45.26 / $94.02	Professional		$28.12	$45.26	$94.02
United Facility/Professional Professional Modifier Low / Median / High Price $52.20 / $76.84 / $125.45	Professional		$52.20	$76.84	$125.45
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.82 / $41.69 / $68.13	Professional	26	$29.82	$41.69	$68.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.12 / $35.07 / $56.46	Professional	TC	$23.12	$35.07	$56.46