Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.08 / $11.08 / $20.52	Facility	26	$11.08	$11.08	$20.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $48.15 / $56.28 / $119.38	Professional		$48.15	$56.28	$119.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.76 / $12.87 / $25.74	Professional	26	$10.76	$12.87	$25.74
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $22.50 / $26.12 / $37.61	Professional	52	$22.50	$26.12	$37.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $36.39 / $41.81 / $81.99	Professional	TC	$36.39	$41.81	$81.99
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $55.28 / $88.09 / $105.01	Professional		$55.28	$88.09	$105.01
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $11.35 / $16.92 / $21.12	Professional	26	$11.35	$16.92	$21.12
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $50.54 / $78.50 / $130.90	Professional		$50.54	$78.50	$130.90
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.26 / $17.64 / $29.65	Professional	26	$11.26	$17.64	$29.65
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $39.25 / $60.84 / $103.54	Professional	TC	$39.25	$60.84	$103.54
CareSource Facility/Professional Professional Modifier Low / Median / High Price $11.50 / $47.98 / $69.50	Professional		$11.50	$47.98	$69.50
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.55 / $13.55 / $13.55	Facility	26	$13.55	$13.55	$13.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $54.61 / $75.69 / $132.61	Professional		$54.61	$75.69	$132.61
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.53 / $17.23 / $30.89	Professional	26	$12.53	$17.23	$30.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $41.97 / $57.79 / $101.50	Professional	TC	$41.97	$57.79	$101.50
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $54.98 / $71.47 / $268.00	Professional		$54.98	$71.47	$268.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $11.35 / $14.76 / $61.64	Professional	26	$11.35	$14.76	$61.64
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $42.66 / $42.66 / $62.01	Professional	52	$42.66	$42.66	$62.01
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $43.62 / $56.71 / $206.36	Professional	TC	$43.62	$56.71	$206.36
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $12.17 / $52.30 / $89.74	Professional		$12.17	$52.30	$89.74
United Facility/Professional Professional Modifier Low / Median / High Price $48.07 / $70.72 / $128.74	Professional		$48.07	$70.72	$128.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.36 / $16.04 / $25.24	Professional	26	$11.36	$16.04	$25.24
United Facility/Professional Professional Modifier TC Low / Median / High Price $36.43 / $52.38 / $86.79	Professional	TC	$36.43	$52.38	$86.79