Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.00 / $63.52 / $524.00	Facility	26	$55.00	$63.52	$524.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $106.94 / $275.00 / $499.69	Professional		$106.94	$275.00	$499.69
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.46 / $55.00 / $119.15	Professional	26	$37.46	$55.00	$119.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $83.95 / $192.00 / $376.26	Professional	TC	$83.95	$192.00	$376.26
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $81.06 / $93.81 / $179.29	Professional		$81.06	$93.81	$179.29
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $31.05 / $56.70 / $74.39	Professional	26	$31.05	$56.70	$74.39
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $113.60 / $113.60 / $113.60	Professional	TC	$113.60	$113.60	$113.60
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $104.58 / $187.51 / $400.00	Professional		$104.58	$187.51	$400.00
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.31 / $55.97 / $110.66	Professional	26	$38.31	$55.97	$110.66
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $66.26 / $116.37 / $300.97	Professional	TC	$66.26	$116.37	$300.97
CareSource Facility/Professional Professional Modifier Low / Median / High Price $41.11 / $82.02 / $134.85	Professional		$41.11	$82.02	$134.85
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.92 / $45.92 / $45.92	Facility	26	$45.92	$45.92	$45.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.52 / $256.33 / $441.03	Professional		$114.52	$256.33	$441.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.13 / $68.17 / $121.92	Professional	26	$39.13	$68.17	$121.92
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.95 / $169.20 / $341.65	Professional	TC	$72.95	$169.20	$341.65
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $115.62 / $210.22 / $601.27	Professional		$115.62	$210.22	$601.27
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $42.85 / $68.30 / $172.10	Professional	26	$42.85	$68.30	$172.10
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $72.77 / $132.30 / $601.27	Professional	TC	$72.77	$132.30	$601.27
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $54.53 / $100.16 / $189.20	Professional		$54.53	$100.16	$189.20
United Facility/Professional Professional Modifier Low / Median / High Price $113.28 / $199.39 / $379.45	Professional		$113.28	$199.39	$379.45
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.28 / $54.80 / $95.73	Professional	26	$39.28	$54.80	$95.73
United Facility/Professional Professional Modifier TC Low / Median / High Price $68.91 / $117.55 / $238.95	Professional	TC	$68.91	$117.55	$238.95