Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $17.78 / $19.95	Facility	26	$16.98	$17.78	$19.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $79.43 / $263.03	Professional		$54.95	$79.43	$263.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $21.88 / $75.86	Professional	26	$16.22	$21.88	$75.86
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $28.84 / $245.47 / $245.47	Professional	50	$28.84	$245.47	$245.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $46.77 / $87.10	Professional	TC	$38.02	$46.77	$87.10
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $79.43 / $112.20	Professional		$56.23	$79.43	$112.20
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $22.91 / $33.88	Professional	26	$15.85	$22.91	$33.88
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $77.62 / $102.33	Professional		$51.29	$77.62	$102.33
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $25.70 / $33.11	Professional	26	$16.98	$25.70	$33.11
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $52.48 / $74.13	Professional	TC	$35.48	$52.48	$74.13
CareSource Facility/Professional Professional Modifier Low / Median / High Price $21.88 / $50.12 / $83.18	Professional		$21.88	$50.12	$83.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $83.18 / $144.54	Professional		$60.26	$83.18	$144.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $25.70 / $47.86	Professional	26	$19.50	$25.70	$47.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $57.54 / $100.00	Professional	TC	$40.74	$57.54	$100.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $85.11 / $281.84	Professional		$69.18	$85.11	$281.84
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $23.99 / $91.20	Professional	26	$19.50	$23.99	$91.20
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $38.02 / $38.02 / $69.18	Professional	52	$38.02	$38.02	$69.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $60.26 / $194.98	Professional	TC	$48.98	$60.26	$194.98
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $20.42 / $60.26 / $117.49	Professional		$20.42	$60.26	$117.49
United Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $79.43 / $144.54	Professional		$57.54	$79.43	$144.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $25.12 / $42.66	Professional	26	$17.78	$25.12	$42.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $53.70 / $102.33	Professional	TC	$39.81	$53.70	$102.33