Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.60 / $41.63 / $145.60	Facility	26	$28.60	$41.63	$145.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $95.75 / $172.35 / $314.27	Professional		$95.75	$172.35	$314.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.19 / $47.18 / $95.00	Professional	26	$28.19	$47.18	$95.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $45.80 / $53.41 / $136.30	Professional	52	$45.80	$53.41	$136.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $70.09 / $96.12 / $226.18	Professional	TC	$70.09	$96.12	$226.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $88.26 / $148.47 / $211.88	Professional		$88.26	$148.47	$211.88
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $24.67 / $47.56 / $59.04	Professional	26	$24.67	$47.56	$59.04
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $21.90 / $22.06 / $52.97	Professional	52	$21.90	$22.06	$52.97
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $69.56 / $98.54 / $145.71	Professional	TC	$69.56	$98.54	$145.71
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $95.93 / $142.65 / $278.83	Professional		$95.93	$142.65	$278.83
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $28.93 / $43.57 / $76.93	Professional	26	$28.93	$43.57	$76.93
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $63.96 / $97.23 / $202.99	Professional	TC	$63.96	$97.23	$202.99
CareSource Facility/Professional Professional Modifier Low / Median / High Price $32.72 / $83.35 / $159.47	Professional		$32.72	$83.35	$159.47
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.42 / $37.42 / $37.42	Facility	26	$37.42	$37.42	$37.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.47 / $168.80 / $287.77	Professional		$102.47	$168.80	$287.77
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.14 / $49.79 / $87.46	Professional	26	$33.14	$49.79	$87.46
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $69.75 / $120.03 / $216.75	Professional	TC	$69.75	$120.03	$216.75
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $114.12 / $136.94 / $357.05	Professional		$114.12	$136.94	$357.05
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $31.80 / $43.18 / $116.92	Professional	26	$31.80	$43.18	$116.92
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $104.51 / $104.51 / $146.86	Professional	52	$104.51	$104.51	$146.86
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $82.32 / $98.78 / $302.70	Professional	TC	$82.32	$98.78	$302.70
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $33.39 / $103.83 / $183.41	Professional		$33.39	$103.83	$183.41
United Facility/Professional Professional Modifier Low / Median / High Price $109.86 / $148.96 / $266.47	Professional		$109.86	$148.96	$266.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.86 / $44.03 / $75.31	Professional	26	$32.86	$44.03	$75.31
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.53 / $106.62 / $191.15	Professional	TC	$77.53	$106.62	$191.15