Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.95 / $123.03 / $309.03	Facility	26	$54.95	$123.03	$309.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $281.84 / $645.65	Professional		$186.21	$281.84	$645.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $81.28 / $186.21	Professional	26	$53.70	$81.28	$186.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $218.78 / $416.87	Professional	TC	$131.83	$218.78	$416.87
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $173.78 / $354.81	Professional		$64.57	$173.78	$354.81
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $56.23 / $107.15	Professional	26	$44.67	$56.23	$107.15
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $93.33 / $114.82	Professional	TC	$93.33	$93.33	$114.82
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $363.08 / $660.69	Professional		$223.87	$363.08	$660.69
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $87.10 / $138.04	Professional	26	$56.23	$87.10	$138.04
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $269.15 / $537.03	Professional	TC	$162.18	$269.15	$537.03
CareSource Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $138.04 / $245.47	Professional		$60.26	$138.04	$245.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $436.52 / $758.58	Professional		$229.09	$436.52	$758.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $95.50 / $165.96	Professional	26	$58.88	$95.50	$165.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $323.59 / $616.60	Professional	TC	$165.96	$323.59	$616.60
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $257.04 / $1,096.48	Professional		$199.53	$257.04	$1,096.48
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $79.43 / $208.93	Professional	26	$58.88	$79.43	$208.93
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $181.97 / $1,096.48	Professional	TC	$141.25	$181.97	$1,096.48
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $181.97 / $323.59	Professional		$60.26	$181.97	$323.59
United Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $389.05 / $630.96	Professional		$213.80	$389.05	$630.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $81.28 / $147.91	Professional	26	$60.26	$81.28	$147.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $281.84 / $489.78	Professional	TC	$147.91	$281.84	$489.78