Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.14 / $47.31 / $139.44	Facility	26	$41.14	$47.31	$139.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $90.60 / $151.40 / $480.00	Professional		$90.60	$151.40	$480.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.14 / $59.07 / $155.69	Professional	26	$41.14	$59.07	$155.69
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $44.51 / $50.81 / $159.25	Professional	52	$44.51	$50.81	$159.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $46.82 / $71.45 / $208.89	Professional	TC	$46.82	$71.45	$208.89
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $93.18 / $159.97 / $168.70	Professional		$93.18	$159.97	$168.70
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $43.13 / $62.93 / $77.55	Professional	26	$43.13	$62.93	$77.55
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $23.30 / $108.64 / $108.64	Professional	52	$23.30	$108.64	$108.64
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $51.02 / $51.02 / $51.02	Professional	TC	$51.02	$51.02	$51.02
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $83.42 / $175.15 / $318.72	Professional		$83.42	$175.15	$318.72
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $34.35 / $69.93 / $134.11	Professional	26	$34.35	$69.93	$134.11
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $46.22 / $97.70 / $196.17	Professional	TC	$46.22	$97.70	$196.17
CareSource Facility/Professional Professional Modifier Low / Median / High Price $48.47 / $67.20 / $136.74	Professional		$48.47	$67.20	$136.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.32 / $211.43 / $378.31	Professional		$112.32	$211.43	$378.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.56 / $88.22 / $147.12	Professional	26	$47.56	$88.22	$147.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $68.08 / $123.30 / $212.42	Professional	TC	$68.08	$123.30	$212.42
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $102.50 / $121.13 / $723.17	Professional		$102.50	$121.13	$723.17
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $46.00 / $54.37 / $323.20	Professional	26	$46.00	$54.37	$323.20
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $61.53 / $61.53 / $111.38	Professional	52	$61.53	$61.53	$111.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $56.50 / $66.77 / $723.17	Professional	TC	$56.50	$66.77	$723.17
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $63.46 / $84.74 / $190.21	Professional		$63.46	$84.74	$190.21
United Facility/Professional Professional Modifier Low / Median / High Price $107.03 / $209.93 / $334.90	Professional		$107.03	$209.93	$334.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.86 / $80.87 / $130.93	Professional	26	$43.86	$80.87	$130.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $65.48 / $126.02 / $197.24	Professional	TC	$65.48	$126.02	$197.24