Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.00 / $55.00 / $181.28	Facility	26	$55.00	$55.00	$181.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $171.00 / $275.00 / $673.00	Professional		$171.00	$275.00	$673.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.08 / $69.90 / $175.00	Professional	26	$40.08	$69.90	$175.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $69.78 / $137.50 / $248.04	Professional	52	$69.78	$137.50	$248.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $119.70 / $220.00 / $372.34	Professional	TC	$119.70	$220.00	$372.34
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $84.76 / $131.07 / $213.51	Professional		$84.76	$131.07	$213.51
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.13 / $49.52 / $75.01	Professional	26	$30.13	$49.52	$75.01
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $153.62 / $153.62 / $153.62	Professional	TC	$153.62	$153.62	$153.62
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $126.34 / $231.38 / $430.72	Professional		$126.34	$231.38	$430.72
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $39.27 / $61.23 / $120.78	Professional	26	$39.27	$61.23	$120.78
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $87.70 / $149.44 / $309.68	Professional	TC	$87.70	$149.44	$309.68
CareSource Facility/Professional Professional Modifier Low / Median / High Price $41.44 / $95.40 / $174.26	Professional		$41.44	$95.40	$174.26
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.27 / $46.27 / $46.27	Facility	26	$46.27	$46.27	$46.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $137.30 / $294.31 / $503.99	Professional		$137.30	$294.31	$503.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.98 / $76.56 / $129.15	Professional	26	$42.98	$76.56	$129.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $96.08 / $202.68 / $392.02	Professional	TC	$96.08	$202.68	$392.02
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $138.68 / $252.14 / $734.21	Professional		$138.68	$252.14	$734.21
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $43.20 / $78.54 / $159.94	Professional	26	$43.20	$78.54	$159.94
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $115.45 / $115.45 / $162.25	Professional	52	$115.45	$115.45	$162.25
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $95.47 / $173.58 / $642.41	Professional	TC	$95.47	$173.58	$642.41
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $56.72 / $127.81 / $226.93	Professional		$56.72	$127.81	$226.93
United Facility/Professional Professional Modifier Low / Median / High Price $134.19 / $243.97 / $494.18	Professional		$134.19	$243.97	$494.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.52 / $62.78 / $107.95	Professional	26	$43.52	$62.78	$107.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $165.33 / $313.35	Professional	TC	$91.20	$165.33	$313.35