Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.28 / $38.03 / $172.38	Facility	26	$33.28	$38.03	$172.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $65.51 / $130.40 / $355.75	Professional		$65.51	$130.40	$355.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.04 / $43.63 / $104.54	Professional	26	$33.04	$43.63	$104.54
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $95.26 / $95.26 / $95.26	Professional	52	$95.26	$95.26	$95.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $70.09 / $94.39 / $232.71	Professional	TC	$70.09	$94.39	$232.71
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $93.78 / $138.75 / $226.34	Professional		$93.78	$138.75	$226.34
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $31.16 / $53.91 / $68.70	Professional	26	$31.16	$53.91	$68.70
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $77.61 / $77.61 / $77.61	Professional	TC	$77.61	$77.61	$77.61
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $152.13 / $292.83	Professional		$114.82	$152.13	$292.83
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $34.54 / $46.84 / $89.17	Professional	26	$34.54	$46.84	$89.17
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $80.19 / $105.45 / $203.67	Professional	TC	$80.19	$105.45	$203.67
CareSource Facility/Professional Professional Modifier Low / Median / High Price $39.03 / $93.29 / $170.74	Professional		$39.03	$93.29	$170.74
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.97 / $43.97 / $43.97	Facility	26	$43.97	$43.97	$43.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $124.44 / $196.56 / $337.73	Professional		$124.44	$196.56	$337.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.21 / $60.31 / $102.84	Professional	26	$39.21	$60.31	$102.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $86.46 / $138.97 / $234.89	Professional	TC	$86.46	$138.97	$234.89
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $134.10 / $213.78 / $753.00	Professional		$134.10	$213.78	$753.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $40.71 / $55.52 / $136.07	Professional	26	$40.71	$55.52	$136.07
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $111.65 / $111.65 / $156.88	Professional	52	$111.65	$111.65	$156.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $93.39 / $127.35 / $326.54	Professional	TC	$93.39	$127.35	$326.54
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $53.30 / $126.42 / $211.18	Professional		$53.30	$126.42	$211.18
United Facility/Professional Professional Modifier Low / Median / High Price $122.58 / $180.06 / $298.75	Professional		$122.58	$180.06	$298.75
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.79 / $55.82 / $89.42	Professional	26	$39.79	$55.82	$89.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $87.09 / $128.22 / $206.97	Professional	TC	$87.09	$128.22	$206.97