Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.53 / $36.00 / $161.96	Facility	26	$31.53	$36.00	$161.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $105.45 / $185.48 / $421.98	Professional		$105.45	$185.48	$421.98
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.53 / $42.86 / $104.53	Professional	26	$31.53	$42.86	$104.53
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $17.75 / $59.00 / $726.00	Professional	52	$17.75	$59.00	$726.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $74.89 / $99.73 / $246.07	Professional	TC	$74.89	$99.73	$246.07
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $96.25 / $164.18 / $231.05	Professional		$96.25	$164.18	$231.05
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $51.06 / $65.11	Professional	26	$29.51	$51.06	$65.11
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $22.65 / $23.88 / $83.57	Professional	52	$22.65	$23.88	$83.57
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $75.56 / $81.77 / $81.77	Professional	TC	$75.56	$81.77	$81.77
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $117.56 / $155.51 / $299.05	Professional		$117.56	$155.51	$299.05
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $32.64 / $44.26 / $83.72	Professional	26	$32.64	$44.26	$83.72
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $84.78 / $111.71 / $215.32	Professional	TC	$84.78	$111.71	$215.32
CareSource Facility/Professional Professional Modifier Low / Median / High Price $36.92 / $98.24 / $179.43	Professional		$36.92	$98.24	$179.43
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.28 / $41.28 / $41.28	Facility	26	$41.28	$41.28	$41.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $127.13 / $201.39 / $344.88	Professional		$127.13	$201.39	$344.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.76 / $56.98 / $98.29	Professional	26	$36.76	$56.98	$98.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $90.87 / $146.85 / $248.33	Professional	TC	$90.87	$146.85	$248.33
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $116.63 / $158.52 / $473.68	Professional		$116.63	$158.52	$473.68
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $38.58 / $52.61 / $128.97	Professional	26	$38.58	$52.61	$128.97
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $113.97 / $113.97 / $160.15	Professional	52	$113.97	$113.97	$160.15
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $98.31 / $134.06 / $345.02	Professional	TC	$98.31	$134.06	$345.02
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $49.60 / $129.79 / $214.13	Professional		$49.60	$129.79	$214.13
United Facility/Professional Professional Modifier Low / Median / High Price $127.82 / $187.94 / $305.07	Professional		$127.82	$187.94	$305.07
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.95 / $52.07 / $86.23	Professional	26	$36.95	$52.07	$86.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $89.97 / $132.63 / $220.01	Professional	TC	$89.97	$132.63	$220.01