Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $64.57 / $123.03	Professional		$51.29	$64.57	$123.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $26.92 / $74.13	Professional	26	$19.95	$26.92	$74.13
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $51.29 / $70.79 / $125.89	Professional	52	$51.29	$70.79	$125.89
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $33.88 / $69.18	Professional	TC	$25.70	$33.88	$69.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $72.44 / $112.20	Professional		$57.54	$72.44	$112.20
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $38.02 / $51.29	Professional	26	$24.55	$38.02	$51.29
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $33.88 / $54.95	Professional	TC	$31.62	$33.88	$54.95
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $70.79 / $104.71	Professional		$57.54	$70.79	$104.71
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $28.18 / $46.77	Professional	26	$21.38	$28.18	$46.77
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $85.11 / $104.71 / $158.49	Professional	50	$85.11	$104.71	$158.49
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $43.65 / $63.10	Professional	TC	$32.36	$43.65	$63.10
CareSource Facility/Professional Facility Modifier Low / Median / High Price $30.20 / $46.77 / $89.13	Facility		$30.20	$46.77	$89.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $81.28 / $134.90	Professional		$46.77	$81.28	$134.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $31.62 / $58.88	Professional	26	$20.42	$31.62	$58.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $41.69 / $83.18	Professional	TC	$25.70	$41.69	$83.18
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $70.79 / $162.18	Professional		$51.29	$70.79	$162.18
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $29.51 / $85.11	Professional	26	$21.38	$29.51	$85.11
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $44.67 / $44.67 / $44.67	Professional	52	$44.67	$44.67	$44.67
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $41.69 / $162.18	Professional	TC	$30.20	$41.69	$162.18
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $50.12 / $95.50	Professional		$35.48	$50.12	$95.50
United Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $69.18 / $107.15	Professional		$51.29	$69.18	$107.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $28.18 / $39.81	Professional	26	$21.88	$28.18	$39.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $38.90 / $67.61	Professional	TC	$28.18	$38.90	$67.61