Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.00 / $71.79 / $236.65	Facility	26	$55.00	$71.79	$236.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $147.69 / $275.00 / $631.03	Professional		$147.69	$275.00	$631.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.89 / $55.75 / $177.93	Professional	26	$46.89	$55.75	$177.93
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $72.93 / $137.50 / $318.19	Professional	52	$72.93	$137.50	$318.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $91.32 / $220.00 / $447.75	Professional	TC	$91.32	$220.00	$447.75
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $88.38 / $116.89 / $224.99	Professional		$88.38	$116.89	$224.99
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $37.88 / $56.82 / $91.60	Professional	26	$37.88	$56.82	$91.60
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $75.89 / $141.02 / $144.49	Professional	TC	$75.89	$141.02	$144.49
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $131.25 / $238.86 / $481.22	Professional		$131.25	$238.86	$481.22
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $49.34 / $71.81 / $142.26	Professional	26	$49.34	$71.81	$142.26
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $83.34 / $152.79 / $336.15	Professional	TC	$83.34	$152.79	$336.15
CareSource Facility/Professional Professional Modifier Low / Median / High Price $52.09 / $101.21 / $168.16	Professional		$52.09	$101.21	$168.16
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.64 / $58.64 / $58.64	Facility	26	$58.64	$58.64	$58.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $159.38 / $320.87 / $569.24	Professional		$159.38	$320.87	$569.24
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.28 / $87.90 / $156.47	Professional	26	$51.28	$87.90	$156.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $101.21 / $225.92 / $431.74	Professional	TC	$101.21	$225.92	$431.74
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $144.07 / $261.94 / $765.74	Professional		$144.07	$261.94	$765.74
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $54.27 / $86.52 / $233.91	Professional	26	$54.27	$86.52	$233.91
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $119.95 / $119.95 / $168.55	Professional	52	$119.95	$119.95	$168.55
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $89.79 / $163.26 / $763.02	Professional	TC	$89.79	$163.26	$763.02
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $69.08 / $122.98 / $235.75	Professional		$69.08	$122.98	$235.75
United Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $273.02 / $497.23	Professional		$144.54	$273.02	$497.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.39 / $73.43 / $129.75	Professional	26	$52.39	$73.43	$129.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $96.51 / $187.34 / $397.14	Professional	TC	$96.51	$187.34	$397.14