Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.00 / $79.67 / $270.44	Facility	26	$55.00	$79.67	$270.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $171.00 / $275.00 / $551.36	Professional		$171.00	$275.00	$551.36
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.00 / $80.20 / $193.58	Professional	26	$55.00	$80.20	$193.58
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $110.50 / $220.00 / $363.00	Professional	TC	$110.50	$220.00	$363.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $114.11 / $131.91 / $197.08	Professional		$114.11	$131.91	$197.08
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $48.46 / $76.95 / $109.08	Professional	26	$48.46	$76.95	$109.08
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $147.94 / $252.11 / $460.37	Professional		$147.94	$252.11	$460.37
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.63 / $81.48 / $167.50	Professional	26	$57.63	$81.48	$167.50
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $89.94 / $160.61 / $308.60	Professional	TC	$89.94	$160.61	$308.60
CareSource Facility/Professional Professional Modifier Low / Median / High Price $62.00 / $110.42 / $190.10	Professional		$62.00	$110.42	$190.10
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.44 / $69.44 / $69.44	Facility	26	$69.44	$69.44	$69.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $165.09 / $326.64 / $556.04	Professional		$165.09	$326.64	$556.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.06 / $99.06 / $182.92	Professional	26	$59.06	$99.06	$182.92
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $101.21 / $209.93 / $384.70	Professional	TC	$101.21	$209.93	$384.70
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $162.58 / $295.60 / $727.35	Professional		$162.58	$295.60	$727.35
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $64.63 / $103.02 / $258.91	Professional	26	$64.63	$103.02	$258.91
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $97.96 / $178.10 / $663.44	Professional	TC	$97.96	$178.10	$663.44
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $82.65 / $136.00 / $272.77	Professional		$82.65	$136.00	$272.77
United Facility/Professional Professional Modifier Low / Median / High Price $166.85 / $263.76 / $458.07	Professional		$166.85	$263.76	$458.07
United Facility/Professional Professional Modifier 26 Low / Median / High Price $55.83 / $81.62 / $143.97	Professional	26	$55.83	$81.62	$143.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $99.20 / $186.32 / $320.70	Professional	TC	$99.20	$186.32	$320.70