Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $264.95 / $2,800.00 / $6,915.00	Facility		$264.95	$2,800.00	$6,915.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.95 / $61.85 / $90.65	Facility	26	$39.95	$61.85	$90.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $172.14 / $234.73 / $442.58	Professional		$172.14	$234.73	$442.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.32 / $47.94 / $120.39	Professional	26	$39.32	$47.94	$120.39
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $108.99 / $161.02 / $220.72	Professional	TC	$108.99	$161.02	$220.72
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $148.72 / $270.70 / $298.88	Professional		$148.72	$270.70	$298.88
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $68.68 / $68.68 / $70.76	Professional	26	$68.68	$68.68	$70.76
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $109.00 / $109.00 / $109.00	Professional	TC	$109.00	$109.00	$109.00
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 $160.97 / $246.74 / $487.53	Professional		$160.97	$246.74	$487.53
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $41.52 / $66.45 / $126.65	Professional	26	$41.52	$66.45	$126.65
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $106.12 / $195.39 / $384.55	Professional	TC	$106.12	$195.39	$384.55
CareSource Facility/Professional Facility Modifier Low / Median / High Price $47.16 / $152.35 / $215.24	Facility		$47.16	$152.35	$215.24
CareSource Facility/Professional Professional Modifier Low / Median / High Price $49.21 / $145.94 / $246.28	Professional		$49.21	$145.94	$246.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $146.47 / $267.20 / $449.14	Professional		$146.47	$267.20	$449.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.20 / $73.16 / $118.53	Professional	26	$46.20	$73.16	$118.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $90.58 / $194.52 / $332.65	Professional	TC	$90.58	$194.52	$332.65
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $160.97 / $209.27 / $405.94	Professional		$160.97	$209.27	$405.94
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $38.11 / $49.54 / $155.61	Professional	26	$38.11	$49.54	$155.61
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $122.87 / $159.72 / $405.94	Professional	TC	$122.87	$159.72	$405.94
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $63.26 / $180.64 / $261.52	Professional		$63.26	$180.64	$261.52
United Facility/Professional Facility Modifier Low / Median / High Price $212.00 / $1,550.00 / $2,665.00	Facility		$212.00	$1,550.00	$2,665.00
United Facility/Professional Professional Modifier Low / Median / High Price $146.50 / $224.29 / $437.14	Professional		$146.50	$224.29	$437.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.83 / $68.13 / $111.81	Professional	26	$41.83	$68.13	$111.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $91.01 / $170.41 / $339.95	Professional	TC	$91.01	$170.41	$339.95