Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $49.77 / $62.95 / $123.14	Professional		$49.77	$62.95	$123.14
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.06 / $27.08 / $62.12	Professional	26	$21.06	$27.08	$62.12
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $22.70 / $30.43 / $60.89	Professional	52	$22.70	$30.43	$60.89
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.56 / $34.00 / $68.54	Professional	TC	$26.56	$34.00	$68.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $56.81 / $61.63 / $104.03	Professional		$56.81	$61.63	$104.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.29 / $38.29 / $38.29	Professional	26	$38.29	$38.29	$38.29
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $46.62 / $70.86 / $124.67	Professional		$46.62	$70.86	$124.67
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.41 / $29.50 / $50.89	Professional	26	$19.41	$29.50	$50.89
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $27.21 / $41.35 / $71.79	Professional	TC	$27.21	$41.35	$71.79
CareSource Facility/Professional Facility Modifier Low / Median / High Price $29.44 / $45.68 / $85.51	Facility		$29.44	$45.68	$85.51
CareSource Facility/Professional Professional Modifier Low / Median / High Price $25.91 / $34.29 / $60.22	Professional		$25.91	$34.29	$60.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $46.05 / $83.39 / $140.96	Professional		$46.05	$83.39	$140.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.78 / $32.35 / $61.17	Professional	26	$19.78	$32.35	$61.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.16 / $45.85 / $86.27	Professional	TC	$25.16	$45.85	$86.27
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $48.86 / $67.19 / $160.87	Professional		$48.86	$67.19	$160.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $20.46 / $28.13 / $85.74	Professional	26	$20.46	$28.13	$85.74
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $44.17 / $44.17 / $44.17	Professional	52	$44.17	$44.17	$44.17
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $28.42 / $39.07 / $160.87	Professional	TC	$28.42	$39.07	$160.87
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $35.56 / $55.76 / $119.00	Professional		$35.56	$55.76	$119.00
United Facility/Professional Professional Modifier Low / Median / High Price $51.32 / $67.45 / $109.06	Professional		$51.32	$67.45	$109.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.16 / $28.13 / $44.31	Professional	26	$22.16	$28.13	$44.31
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.94 / $38.54 / $68.45	Professional	TC	$27.94	$38.54	$68.45