Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.62 / $15.51 / $44.74	Facility	26	$11.62	$15.51	$44.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $63.56 / $94.90 / $196.27	Professional		$63.56	$94.90	$196.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.50 / $14.00 / $37.09	Professional	26	$11.50	$14.00	$37.09
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $38.25 / $41.96 / $83.47	Professional	52	$38.25	$41.96	$83.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $67.08 / $81.41 / $170.06	Professional	TC	$67.08	$81.41	$170.06
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $60.62 / $96.27 / $147.13	Professional		$60.62	$96.27	$147.13
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $9.69 / $17.93 / $21.24	Professional	26	$9.69	$17.93	$21.24
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $23.20 / $23.20 / $23.20	Professional	52	$23.20	$23.20	$23.20
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $57.64 / $57.64 / $57.64	Professional	TC	$57.64	$57.64	$57.64
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $71.31 / $114.22 / $223.97	Professional		$71.31	$114.22	$223.97
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.76 / $15.63 / $30.30	Professional	26	$10.76	$15.63	$30.30
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $58.92 / $98.87 / $193.67	Professional	TC	$58.92	$98.87	$193.67
CareSource Facility/Professional Professional Modifier Low / Median / High Price $11.70 / $68.59 / $109.49	Professional		$11.70	$68.59	$109.49
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.54 / $13.54 / $22.32	Facility	26	$13.54	$13.54	$22.32
Cigna Facility/Professional Professional Modifier Low / Median / High Price $78.75 / $126.30 / $232.19	Professional		$78.75	$126.30	$232.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.19 / $17.09 / $32.46	Professional	26	$12.19	$17.09	$32.46
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $70.56 / $112.37 / $198.68	Professional	TC	$70.56	$112.37	$198.68
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $87.18 / $118.88 / $278.62	Professional		$87.18	$118.88	$278.62
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $12.58 / $17.16 / $56.41	Professional	26	$12.58	$17.16	$56.41
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $53.85 / $53.85 / $80.59	Professional	52	$53.85	$53.85	$80.59
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $74.59 / $101.72 / $249.57	Professional	TC	$74.59	$101.72	$249.57
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $12.42 / $76.44 / $130.94	Professional		$12.42	$76.44	$130.94
United Facility/Professional Professional Modifier Low / Median / High Price $85.17 / $126.08 / $213.54	Professional		$85.17	$126.08	$213.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.66 / $17.18 / $30.95	Professional	26	$12.66	$17.18	$30.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $73.48 / $110.68 / $187.17	Professional	TC	$73.48	$110.68	$187.17