Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.74 / $60.26 / $218.78	Facility	26	$40.74	$60.26	$218.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $194.98 / $616.60	Professional		$131.83	$194.98	$616.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $58.88 / $147.91	Professional	26	$40.74	$58.88	$147.91
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $30.20 / $30.20 / $30.20	Professional	52	$30.20	$30.20	$30.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $120.23 / $288.40	Professional	TC	$91.20	$120.23	$288.40
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $147.91 / $269.15	Professional		$109.65	$147.91	$269.15
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $54.95 / $85.11	Professional	26	$37.15	$54.95	$85.11
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $93.33 / $125.89	Professional	TC	$79.43	$93.33	$125.89
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $190.55 / $309.03	Professional		$154.88	$190.55	$309.03
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $57.54 / $91.20	Professional	26	$45.71	$57.54	$91.20
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $134.90 / $218.78	Professional	TC	$109.65	$134.90	$218.78
CareSource Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $117.49 / $194.98	Professional		$47.86	$117.49	$194.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $239.88 / $398.11	Professional		$141.25	$239.88	$398.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $69.18 / $123.03	Professional	26	$41.69	$69.18	$123.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $165.96 / $288.40	Professional	TC	$102.33	$165.96	$288.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $208.93 / $602.56	Professional		$158.49	$208.93	$602.56
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $61.66 / $165.96	Professional	26	$46.77	$61.66	$165.96
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $141.25 / $141.25 / $199.53	Professional	52	$141.25	$141.25	$199.53
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $138.04 / $398.11	Professional	TC	$112.20	$138.04	$398.11
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $144.54 / $263.03	Professional		$48.98	$144.54	$263.03
United Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $218.78 / $363.08	Professional		$154.88	$218.78	$363.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $63.10 / $107.15	Professional	26	$46.77	$63.10	$107.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $154.88 / $251.19	Professional	TC	$107.15	$154.88	$251.19