Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $67.70 / $356.57 / $887.25	Facility		$67.70	$356.57	$887.25
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.84 / $75.44 / $146.15	Facility	26	$37.84	$75.44	$146.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $58.82 / $80.18 / $253.00	Professional		$58.82	$80.18	$253.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.40 / $47.19 / $119.82	Professional	26	$34.40	$47.19	$119.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.98 / $35.02 / $157.97	Professional	TC	$25.98	$35.02	$157.97
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $7,875.00 / $7,875.00 / $7,875.00	Facility		$7,875.00	$7,875.00	$7,875.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $63.42 / $117.68 / $329.42	Professional		$63.42	$117.68	$329.42
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $35.96 / $64.33 / $129.65	Professional	26	$35.96	$64.33	$129.65
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $27.47 / $49.68 / $199.76	Professional	TC	$27.47	$49.68	$199.76
CareSource Facility/Professional Facility Modifier Low / Median / High Price $31.81 / $49.94 / $90.32	Facility		$31.81	$49.94	$90.32
CareSource Facility/Professional Professional Modifier Low / Median / High Price $29.53 / $47.90 / $92.05	Professional		$29.53	$47.90	$92.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $76.33 / $183.64 / $362.14	Professional		$76.33	$183.64	$362.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.68 / $87.92 / $139.46	Professional	26	$42.68	$87.92	$139.46
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.57 / $69.97 / $197.75	Professional	TC	$30.57	$69.97	$197.75
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $68.52 / $80.98 / $364.64	Professional		$68.52	$80.98	$364.64
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $39.03 / $46.12 / $208.36	Professional	26	$39.03	$46.12	$208.36
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $29.49 / $34.85 / $302.80	Professional	TC	$29.49	$34.85	$302.80
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $40.43 / $64.93 / $170.58	Professional		$40.43	$64.93	$170.58
United Facility/Professional Facility Modifier Low / Median / High Price $353.00 / $1,580.00 / $2,665.00	Facility		$353.00	$1,580.00	$2,665.00
United Facility/Professional Professional Modifier Low / Median / High Price $65.73 / $137.05 / $313.70	Professional		$65.73	$137.05	$313.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.59 / $76.00 / $128.22	Professional	26	$38.59	$76.00	$128.22
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.97 / $58.37 / $186.16	Professional	TC	$28.97	$58.37	$186.16