Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $120.23 / $331.13	Facility	26	$85.11	$120.23	$331.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $436.52 / $1,230.27	Professional		$208.93	$436.52	$1,230.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $112.20 / $281.84	Professional	26	$66.07	$112.20	$281.84
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $199.53 / $562.34 / $1,230.27	Professional	52	$199.53	$562.34	$1,230.27
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $281.84 / $562.34	Professional	TC	$123.03	$281.84	$562.34
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $181.97 / $323.59	Professional		$134.90	$181.97	$323.59
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $72.44 / $125.89	Professional	26	$54.95	$72.44	$125.89
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $107.15 / $165.96	Professional	TC	$83.18	$107.15	$165.96
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $467.74 / $831.76	Professional		$218.78	$467.74	$831.76
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $97.72 / $154.88	Professional	26	$72.44	$97.72	$154.88
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $323.59 / $707.95	Professional	TC	$147.91	$323.59	$707.95
CareSource Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $131.83 / $239.88	Professional		$72.44	$131.83	$239.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $501.19 / $977.24	Professional		$213.80	$501.19	$977.24
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $107.15 / $204.17	Professional	26	$64.57	$107.15	$204.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $316.23 / $776.25	Professional	TC	$141.25	$316.23	$776.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $251.19 / $1,479.11	Professional		$194.98	$251.19	$1,479.11
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $93.33 / $251.19	Professional	26	$69.18	$93.33	$251.19
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $173.78 / $173.78 / $239.88	Professional	52	$173.78	$173.78	$239.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $162.18 / $1,174.90	Professional	TC	$125.89	$162.18	$1,174.90
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $173.78 / $323.59	Professional		$72.44	$173.78	$323.59
United Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $371.54 / $776.25	Professional		$199.53	$371.54	$776.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $85.11 / $162.18	Professional	26	$66.07	$85.11	$162.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $239.88 / $588.84	Professional	TC	$128.82	$239.88	$588.84