Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $21.38 / $28.84	Facility	26	$19.95	$21.38	$28.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $38.90 / $83.18	Professional		$30.20	$38.90	$83.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $25.70 / $58.88	Professional	26	$19.95	$25.70	$58.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $10.00 / $12.02 / $28.18	Professional	TC	$10.00	$12.02	$28.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $38.90 / $64.57	Professional		$28.18	$38.90	$64.57
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $26.92 / $41.69	Professional	26	$21.88	$26.92	$41.69
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $8.91 / $10.72 / $15.49	Professional	52	$8.91	$10.72	$15.49
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $22.39 / $22.39	Professional	TC	$22.39	$22.39	$22.39
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $48.98 / $64.57	Professional		$33.11	$48.98	$64.57
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $33.11 / $42.66	Professional	26	$22.39	$33.11	$42.66
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $11.22 / $16.22 / $21.88	Professional	TC	$11.22	$16.22	$21.88
CareSource Facility/Professional Professional Modifier Low / Median / High Price $12.02 / $25.70 / $43.65	Professional		$12.02	$25.70	$43.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $47.86 / $83.18	Professional		$34.67	$47.86	$83.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $32.36 / $53.70	Professional	26	$23.44	$32.36	$53.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $11.48 / $15.85 / $28.84	Professional	TC	$11.48	$15.85	$28.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $44.67 / $107.15	Professional		$35.48	$44.67	$107.15
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $27.54 / $52.48	Professional	26	$21.88	$27.54	$52.48
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $25.70 / $25.70 / $38.02	Professional	52	$25.70	$25.70	$38.02
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $13.80 / $16.98 / $33.88	Professional	TC	$13.80	$16.98	$33.88
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $38.02 / $69.18	Professional		$19.95	$38.02	$69.18
United Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $41.69 / $69.18	Professional		$30.20	$41.69	$69.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $27.54 / $45.71	Professional	26	$20.42	$27.54	$45.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $9.33 / $13.49 / $23.44	Professional	TC	$9.33	$13.49	$23.44