Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.95 / $114.82 / $275.42	Facility	26	$54.95	$114.82	$275.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $281.84 / $691.83	Professional		$169.82	$281.84	$691.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $83.18 / $199.53	Professional	26	$54.95	$83.18	$199.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $199.53 / $331.13	Professional	TC	$114.82	$199.53	$331.13
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $151.36 / $338.84	Professional		$114.82	$151.36	$338.84
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $81.28 / $107.15	Professional	26	$44.67	$81.28	$107.15
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $194.98 / $194.98	Professional	TC	$194.98	$194.98	$194.98
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $302.00 / $549.54	Professional		$199.53	$302.00	$549.54
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $83.18 / $141.25	Professional	26	$54.95	$83.18	$141.25
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $204.17 / $426.58	Professional	TC	$131.83	$204.17	$426.58
CareSource Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $123.03 / $218.78	Professional		$61.66	$123.03	$218.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $371.54 / $630.96	Professional		$181.97	$371.54	$630.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $91.20 / $162.18	Professional	26	$54.95	$91.20	$162.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $263.03 / $489.78	Professional	TC	$123.03	$263.03	$489.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $229.09 / $891.25	Professional		$177.83	$229.09	$891.25
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $79.43 / $213.80	Professional	26	$58.88	$79.43	$213.80
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $151.36 / $891.25	Professional	TC	$117.49	$151.36	$891.25
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $131.83 / $288.40	Professional		$60.26	$131.83	$288.40
United Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $302.00 / $537.03	Professional		$177.83	$302.00	$537.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $75.86 / $141.25	Professional	26	$56.23	$75.86	$141.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $204.17 / $380.19	Professional	TC	$114.82	$204.17	$380.19