Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.00 / $113.27 / $268.95	Facility	26	$55.00	$113.27	$268.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $194.77 / $275.00 / $574.75	Professional		$194.77	$275.00	$574.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.00 / $83.00 / $176.91	Professional	26	$55.00	$83.00	$176.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $119.70 / $220.00 / $425.97	Professional	TC	$119.70	$220.00	$425.97
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $120.81 / $139.72 / $269.05	Professional		$120.81	$139.72	$269.05
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $49.43 / $82.66 / $109.08	Professional	26	$49.43	$82.66	$109.08
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $89.42 / $89.42 / $89.42	Professional	TC	$89.42	$89.42	$89.42
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $164.45 / $276.63 / $509.28	Professional		$164.45	$276.63	$509.28
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $56.24 / $80.69 / $168.43	Professional	26	$56.24	$80.69	$168.43
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $104.45 / $188.36 / $354.65	Professional	TC	$104.45	$188.36	$354.65
CareSource Facility/Professional Professional Modifier Low / Median / High Price $62.00 / $121.23 / $200.91	Professional		$62.00	$121.23	$200.91
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.79 / $69.79 / $69.79	Facility	26	$69.79	$69.79	$69.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $208.68 / $356.42 / $610.54	Professional		$208.68	$356.42	$610.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.71 / $99.06 / $169.84	Professional	26	$58.71	$99.06	$169.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $147.18 / $240.96 / $469.09	Professional	TC	$147.18	$240.96	$469.09
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $172.21 / $313.10 / $868.06	Professional		$172.21	$313.10	$868.06
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $64.63 / $103.02 / $225.08	Professional	26	$64.63	$103.02	$225.08
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $107.58 / $195.60 / $697.55	Professional	TC	$107.58	$195.60	$697.55
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $88.08 / $148.94 / $271.82	Professional		$88.08	$148.94	$271.82
United Facility/Professional Professional Modifier Low / Median / High Price $182.91 / $299.22 / $500.81	Professional		$182.91	$299.22	$500.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.79 / $81.98 / $143.19	Professional	26	$58.79	$81.98	$143.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $124.16 / $214.16 / $355.64	Professional	TC	$124.16	$214.16	$355.64