Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.57 / $20.57 / $28.56	Facility	26	$20.57	$20.57	$28.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $29.99 / $34.97 / $72.79	Professional		$29.99	$34.97	$72.79
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.54 / $22.89 / $49.24	Professional	26	$19.54	$22.89	$49.24
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $14.49 / $16.53 / $20.37	Professional	52	$14.49	$16.53	$20.37
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $9.44 / $11.54 / $21.76	Professional	TC	$9.44	$11.54	$21.76
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $32.06 / $42.48 / $61.99	Professional		$32.06	$42.48	$61.99
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.68 / $37.33 / $41.21	Professional	26	$25.68	$37.33	$41.21
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $8.08 / $10.62 / $10.62	Professional	52	$8.08	$10.62	$10.62
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $19.13 / $19.13 / $19.13	Professional	TC	$19.13	$19.13	$19.13
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $31.25 / $48.90 / $89.39	Professional		$31.25	$48.90	$89.39
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $20.30 / $32.77 / $59.57	Professional	26	$20.30	$32.77	$59.57
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $10.39 / $16.13 / $29.12	Professional	TC	$10.39	$16.13	$29.12
CareSource Facility/Professional Professional Modifier Low / Median / High Price $12.30 / $25.39 / $43.94	Professional		$12.30	$25.39	$43.94
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.15 / $25.15 / $25.15	Facility	26	$25.15	$25.15	$25.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.63 / $47.71 / $84.35	Professional		$34.63	$47.71	$84.35
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.28 / $31.97 / $54.41	Professional	26	$23.28	$31.97	$54.41
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $11.15 / $15.55 / $26.74	Professional	TC	$11.15	$15.55	$26.74
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $33.39 / $43.41 / $164.00	Professional		$33.39	$43.41	$164.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $21.09 / $25.31 / $48.51	Professional	26	$21.09	$25.31	$48.51
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $25.91 / $25.91 / $37.65	Professional	52	$25.91	$25.91	$37.65
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $12.30 / $14.76 / $28.29	Professional	TC	$12.30	$14.76	$28.29
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $13.21 / $26.39 / $52.60	Professional		$13.21	$26.39	$52.60
United Facility/Professional Professional Modifier Low / Median / High Price $30.83 / $43.89 / $68.50	Professional		$30.83	$43.89	$68.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.10 / $29.26 / $46.88	Professional	26	$21.10	$29.26	$46.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $9.66 / $14.15 / $23.28	Professional	TC	$9.66	$14.15	$23.28