Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.95 / $69.18 / $186.21	Facility	26	$54.95	$69.18	$186.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $275.42 / $676.08	Professional		$128.82	$275.42	$676.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $69.18 / $190.55	Professional	26	$37.15	$69.18	$190.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $177.83 / $363.08	Professional	TC	$87.10	$177.83	$363.08
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $120.23 / $213.80	Professional		$91.20	$120.23	$213.80
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $42.66 / $72.44	Professional	26	$31.62	$42.66	$72.44
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $75.86 / $138.04	Professional	TC	$53.70	$75.86	$138.04
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $251.19 / $426.58	Professional		$147.91	$251.19	$426.58
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $67.61 / $114.82	Professional	26	$45.71	$67.61	$114.82
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $181.97 / $309.03	Professional	TC	$102.33	$181.97	$309.03
CareSource Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $95.50 / $158.49	Professional		$41.69	$95.50	$158.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $281.84 / $489.78	Professional		$131.83	$281.84	$489.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $70.79 / $123.03	Professional	26	$39.81	$70.79	$123.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $194.98 / $371.54	Professional	TC	$93.33	$194.98	$371.54
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $169.82 / $645.65	Professional		$131.83	$169.82	$645.65
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $54.95 / $158.49	Professional	26	$40.74	$54.95	$158.49
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $114.82 / $114.82 / $162.18	Professional	52	$114.82	$114.82	$162.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $117.49 / $645.65	Professional	TC	$89.13	$117.49	$645.65
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $117.49 / $218.78	Professional		$41.69	$117.49	$218.78
United Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $223.87 / $407.38	Professional		$128.82	$223.87	$407.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $60.26 / $102.33	Professional	26	$39.81	$60.26	$102.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $154.88 / $302.00	Professional	TC	$87.10	$154.88	$302.00