Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $21.18 / $21.18 / $68.98	Facility		$21.18	$21.18	$68.98
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.83 / $2.83 / $18.26	Facility	26	$2.83	$2.83	$18.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $21.18 / $30.45 / $71.87	Professional		$21.18	$30.45	$71.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $2.83 / $3.77 / $10.86	Professional	26	$2.83	$3.77	$10.86
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $9.19 / $10.95 / $32.71	Professional	52	$9.19	$10.95	$32.71
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.16 / $22.95 / $43.34	Professional	TC	$18.16	$22.95	$43.34
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $41.48 / $41.48 / $41.48	Professional		$41.48	$41.48	$41.48
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $19.93 / $32.02 / $66.58	Professional		$19.93	$32.02	$66.58
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $2.93 / $5.12 / $15.34	Professional	26	$2.93	$5.12	$15.34
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $29.66 / $47.49 / $100.36	Professional	50	$29.66	$47.49	$100.36
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $17.13 / $25.15 / $52.87	Professional	TC	$17.13	$25.15	$52.87
CareSource Facility/Professional Facility Modifier Low / Median / High Price $3.69 / $24.06 / $31.28	Facility		$3.69	$24.06	$31.28
CareSource Facility/Professional Professional Modifier Low / Median / High Price $2.95 / $19.80 / $33.86	Professional		$2.95	$19.80	$33.86
Cigna Facility/Professional Facility Modifier Low / Median / High Price $26.10 / $26.10 / $26.10	Facility		$26.10	$26.10	$26.10
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.41 / $3.41 / $3.41	Facility	26	$3.41	$3.41	$3.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $19.13 / $38.95 / $76.56	Professional		$19.13	$38.95	$76.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $2.94 / $6.44 / $17.86	Professional	26	$2.94	$6.44	$17.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.05 / $30.87 / $59.33	Professional	TC	$16.05	$30.87	$59.33
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $24.57 / $44.68 / $100.36	Professional		$24.57	$44.68	$100.36
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $3.25 / $5.90 / $35.39	Professional	26	$3.25	$5.90	$35.39
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $21.53 / $25.30 / $25.30	Professional	52	$21.53	$25.30	$25.30
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $21.33 / $38.78 / $89.14	Professional	TC	$21.33	$38.78	$89.14
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $4.73 / $29.27 / $41.33	Professional		$4.73	$29.27	$41.33
United Facility/Professional Professional Modifier Low / Median / High Price $21.21 / $37.29 / $67.44	Professional		$21.21	$37.29	$67.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $3.15 / $5.01 / $15.20	Professional	26	$3.15	$5.01	$15.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.96 / $26.92 / $46.86	Professional	TC	$17.96	$26.92	$46.86