Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.17 / $47.02 / $210.99	Facility	26	$41.17	$47.02	$210.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $130.07 / $176.75 / $495.56	Professional		$130.07	$176.75	$495.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.01 / $52.38 / $132.52	Professional	26	$40.01	$52.38	$132.52
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $89.37 / $117.56 / $296.19	Professional	TC	$89.37	$117.56	$296.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $117.91 / $147.00 / $261.73	Professional		$117.91	$147.00	$261.73
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.22 / $66.12 / $84.33	Professional	26	$38.22	$66.12	$84.33
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $98.87 / $98.87 / $98.87	Professional	TC	$98.87	$98.87	$98.87
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $145.66 / $191.93 / $370.79	Professional		$145.66	$191.93	$370.79
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $42.77 / $58.20 / $109.52	Professional	26	$42.77	$58.20	$109.52
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $100.20 / $134.66 / $261.27	Professional	TC	$100.20	$134.66	$261.27
CareSource Facility/Professional Professional Modifier Low / Median / High Price $48.08 / $118.83 / $217.26	Professional		$48.08	$118.83	$217.26
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.02 / $54.02 / $54.02	Facility	26	$54.02	$54.02	$54.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $157.75 / $249.43 / $427.62	Professional		$157.75	$249.43	$427.62
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.33 / $74.93 / $126.95	Professional	26	$48.33	$74.93	$126.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $110.03 / $177.82 / $301.31	Professional	TC	$110.03	$177.82	$301.31
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $168.89 / $269.25 / $717.00	Professional		$168.89	$269.25	$717.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $49.96 / $68.13 / $169.03	Professional	26	$49.96	$68.13	$169.03
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $140.60 / $140.60 / $197.59	Professional	52	$140.60	$140.60	$197.59
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $118.93 / $162.18 / $417.74	Professional	TC	$118.93	$162.18	$417.74
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $64.88 / $158.59 / $267.70	Professional		$64.88	$158.59	$267.70
United Facility/Professional Professional Modifier Low / Median / High Price $164.29 / $240.11 / $379.01	Professional		$164.29	$240.11	$379.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.46 / $67.88 / $112.19	Professional	26	$48.46	$67.88	$112.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $111.25 / $163.28 / $263.87	Professional	TC	$111.25	$163.28	$263.87