Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $575.44 / $831.76 / $6,918.31	Facility	TC	$575.44	$831.76	$6,918.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $85.11 / $549.54	Professional		$53.70	$85.11	$549.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $100.00 / $851.14	Professional	26	$33.88	$100.00	$851.14
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $51.29 / $257.04	Professional	TC	$25.70	$51.29	$257.04
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $39.81 / $120.23	Professional		$32.36	$39.81	$120.23
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $39.81 / $64.57	Professional	26	$16.98	$39.81	$64.57
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $32.36 / $64.57	Professional	TC	$15.85	$32.36	$64.57
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $102.33 / $181.97	Professional		$42.66	$102.33	$181.97
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $47.86 / $97.72	Professional	26	$23.99	$47.86	$97.72
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $53.70 / $93.33	Professional	TC	$18.20	$53.70	$93.33
CareSource Facility/Professional Facility Modifier Low / Median / High Price $42.66 / $66.07 / $131.83	Facility		$42.66	$66.07	$131.83
CareSource Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $42.66 / $89.13	Professional		$38.02	$42.66	$89.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $67.61 / $208.93	Professional		$35.48	$67.61	$208.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $35.48 / $104.71	Professional	26	$17.78	$35.48	$104.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.49 / $34.67 / $120.23	Professional	TC	$15.49	$34.67	$120.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $107.15 / $562.34	Professional		$64.57	$107.15	$562.34
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $208.93 / $208.93 / $257.04	Professional	22	$208.93	$208.93	$257.04
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $53.70 / $295.12	Professional	26	$31.62	$53.70	$295.12
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $60.26 / $60.26 / $75.86	Professional	52	$60.26	$60.26	$75.86
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $53.70 / $263.03	Professional	TC	$32.36	$53.70	$263.03
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $3,548.13 / $3,548.13 / $3,548.13	Facility		$3,548.13	$3,548.13	$3,548.13
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $66.07 / $131.83	Professional		$34.67	$66.07	$131.83
United Facility/Professional Facility Modifier Low / Median / High Price $22.39 / $22.39 / $56.23	Facility		$22.39	$22.39	$56.23
United Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $89.13 / $204.17	Professional		$42.66	$89.13	$204.17
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $38.90 / $93.33	Professional	26	$22.91	$38.90	$93.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $39.81 / $100.00	Professional	TC	$19.05	$39.81	$100.00