Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $229.09 / $489.78 / $891.25	Facility		$229.09	$489.78	$891.25
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.15 / $117.49 / $144.54	Facility	26	$37.15	$117.49	$144.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $87.10 / $288.40	Professional		$56.23	$87.10	$288.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $47.86 / $123.03	Professional	26	$33.88	$47.86	$123.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $35.48 / $169.82	Professional	TC	$25.70	$35.48	$169.82
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $37.15 / $60.26	Professional		$28.18	$37.15	$60.26
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $50.12 / $72.44	Professional	26	$40.74	$50.12	$72.44
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $12.02 / $17.38 / $25.12	Professional	TC	$12.02	$17.38	$25.12
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $7,943.28 / $7,943.28 / $7,943.28	Facility		$7,943.28	$7,943.28	$7,943.28
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $190.55 / $338.84	Professional		$85.11	$190.55	$338.84
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $85.11 / $138.04	Professional	26	$47.86	$85.11	$138.04
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $114.82 / $204.17	Professional	TC	$28.84	$114.82	$204.17
CareSource Facility/Professional Facility Modifier Low / Median / High Price $30.20 / $51.29 / $93.33	Facility		$30.20	$51.29	$93.33
CareSource Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $47.86 / $83.18	Professional		$31.62	$47.86	$83.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $177.83 / $363.08	Professional		$75.86	$177.83	$363.08
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $85.11 / $141.25	Professional	26	$42.66	$85.11	$141.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $70.79 / $218.78	Professional	TC	$30.90	$70.79	$218.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $87.10 / $478.63	Professional		$70.79	$87.10	$478.63
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $48.98 / $208.93	Professional	26	$39.81	$48.98	$208.93
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $38.90 / $302.00	Professional	TC	$31.62	$38.90	$302.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $114.82 / $251.19	Professional		$48.98	$114.82	$251.19
United Facility/Professional Facility Modifier Low / Median / High Price $213.80 / $1,513.56 / $2,511.89	Facility		$213.80	$1,513.56	$2,511.89
United Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $141.25 / $323.59	Professional		$66.07	$141.25	$323.59
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $74.13 / $125.89	Professional	26	$38.02	$74.13	$125.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $57.54 / $199.53	Professional	TC	$28.18	$57.54	$199.53