Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $581.33 / $806.59 / $6,394.58	Facility	TC	$581.33	$806.59	$6,394.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.20 / $78.30 / $439.91	Professional		$52.20	$78.30	$439.91
Aetna Facility/Professional Professional Modifier 22 Low / Median / High Price $215.59 / $215.59 / $215.59	Professional	22	$215.59	$215.59	$215.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.07 / $70.58 / $555.00	Professional	26	$31.07	$70.58	$555.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $23.73 / $31.69 / $83.63	Professional	52	$23.73	$31.69	$83.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.62 / $38.27 / $130.44	Professional	TC	$26.62	$38.27	$130.44
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $32.20 / $34.75 / $123.00	Professional		$32.20	$34.75	$123.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $16.88 / $39.07 / $64.48	Professional	26	$16.88	$39.07	$64.48
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $15.63 / $56.89 / $65.98	Professional	TC	$15.63	$56.89	$65.98
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $42.34 / $77.25 / $178.56	Professional		$42.34	$77.25	$178.56
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $24.13 / $38.60 / $88.79	Professional	26	$24.13	$38.60	$88.79
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $18.21 / $35.72 / $89.88	Professional	TC	$18.21	$35.72	$89.88
CareSource Facility/Professional Facility Modifier Low / Median / High Price $37.88 / $52.33 / $111.08	Facility		$37.88	$52.33	$111.08
CareSource Facility/Professional Professional Modifier Low / Median / High Price $31.77 / $37.88 / $78.70	Professional		$31.77	$37.88	$78.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.24 / $67.47 / $208.48	Professional		$35.24	$67.47	$208.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.98 / $35.86 / $104.83	Professional	26	$17.98	$35.86	$104.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.45 / $34.97 / $120.34	Professional	TC	$15.45	$34.97	$120.34
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $62.54 / $104.69 / $557.40	Professional		$62.54	$104.69	$557.40
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $206.70 / $206.70 / $259.54	Professional	22	$206.70	$206.70	$259.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $31.45 / $52.64 / $293.89	Professional	26	$31.45	$52.64	$293.89
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $60.29 / $60.29 / $75.70	Professional	52	$60.29	$60.29	$75.70
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $31.10 / $52.05 / $263.58	Professional	TC	$31.10	$52.05	$263.58
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $34.15 / $60.88 / $119.97	Professional		$34.15	$60.88	$119.97
United Facility/Professional Professional Modifier Low / Median / High Price $42.82 / $84.99 / $202.22	Professional		$42.82	$84.99	$202.22
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.85 / $39.34 / $84.52	Professional	26	$22.85	$39.34	$84.52
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.23 / $42.25 / $100.54	Professional	TC	$19.23	$42.25	$100.54