Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.00 / $88.41 / $267.47	Facility	26	$55.00	$88.41	$267.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $204.56 / $294.55 / $691.40	Professional		$204.56	$294.55	$691.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.00 / $83.00 / $175.93	Professional	26	$55.00	$83.00	$175.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $124.43 / $220.00 / $524.50	Professional	TC	$124.43	$220.00	$524.50
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $131.50 / $152.38 / $317.00	Professional		$131.50	$152.38	$317.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $42.30 / $71.19 / $110.97	Professional	26	$42.30	$71.19	$110.97
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $171.34 / $289.24 / $558.46	Professional		$171.34	$289.24	$558.46
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $56.16 / $79.56 / $166.58	Professional	26	$56.16	$79.56	$166.58
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $113.66 / $190.00 / $411.85	Professional	TC	$113.66	$190.00	$411.85
CareSource Facility/Professional Professional Modifier Low / Median / High Price $61.31 / $130.97 / $226.33	Professional		$61.31	$130.97	$226.33
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.05 / $69.05 / $69.05	Facility	26	$69.05	$69.05	$69.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $189.16 / $391.18 / $683.18	Professional		$189.16	$391.18	$683.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.33 / $101.94 / $168.87	Professional	26	$58.33	$101.94	$168.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $127.38 / $275.95 / $520.44	Professional	TC	$127.38	$275.95	$520.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $187.81 / $341.48 / $899.89	Professional		$187.81	$341.48	$899.89
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $63.91 / $101.88 / $223.84	Professional	26	$63.91	$101.88	$223.84
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $123.90 / $225.28 / $899.89	Professional	TC	$123.90	$225.28	$899.89
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $82.99 / $169.73 / $307.33	Professional		$82.99	$169.73	$307.33
United Facility/Professional Professional Modifier Low / Median / High Price $187.58 / $318.14 / $590.08	Professional		$187.58	$318.14	$590.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.46 / $80.44 / $143.41	Professional	26	$58.46	$80.44	$143.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $116.28 / $206.94 / $396.75	Professional	TC	$116.28	$206.94	$396.75