Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.22 / $9.13 / $15.24	Facility	26	$8.22	$9.13	$15.24
Aetna Facility/Professional Professional Modifier Low / Median / High Price $48.86 / $58.97 / $120.71	Professional		$48.86	$58.97	$120.71
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.45 / $9.14 / $19.14	Professional	26	$7.45	$9.14	$19.14
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $22.60 / $27.99 / $39.04	Professional	52	$22.60	$27.99	$39.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $40.84 / $49.36 / $96.49	Professional	TC	$40.84	$49.36	$96.49
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $53.75 / $85.66 / $100.78	Professional		$53.75	$85.66	$100.78
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.22 / $12.33 / $15.70	Professional	26	$8.22	$12.33	$15.70
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $51.43 / $77.98 / $134.52	Professional		$51.43	$77.98	$134.52
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $13.12 / $22.03	Professional	26	$7.94	$13.12	$22.03
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $43.54 / $64.86 / $115.19	Professional	TC	$43.54	$64.86	$115.19
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.49 / $48.86 / $68.30	Professional		$8.49	$48.86	$68.30
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.06 / $10.06 / $10.06	Facility	26	$10.06	$10.06	$10.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $55.25 / $75.77 / $139.69	Professional		$55.25	$75.77	$139.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.01 / $12.27 / $22.58	Professional	26	$9.01	$12.27	$22.58
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $46.00 / $63.84 / $117.96	Professional	TC	$46.00	$63.84	$117.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $54.28 / $70.56 / $278.00	Professional		$54.28	$70.56	$278.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.44 / $10.99 / $41.70	Professional	26	$8.44	$10.99	$41.70
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $42.13 / $42.13 / $61.23	Professional	52	$42.13	$42.13	$61.23
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $45.84 / $59.59 / $236.30	Professional	TC	$45.84	$59.59	$236.30
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $9.31 / $54.17 / $90.22	Professional		$9.31	$54.17	$90.22
United Facility/Professional Professional Modifier Low / Median / High Price $49.92 / $70.00 / $110.66	Professional		$49.92	$70.00	$110.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.16 / $11.22 / $18.68	Professional	26	$8.16	$11.22	$18.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $41.20 / $57.66 / $93.38	Professional	TC	$41.20	$57.66	$93.38