Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.00 / $55.00 / $82.50	Facility	26	$55.00	$55.00	$82.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $145.59 / $275.00 / $364.32	Professional		$145.59	$275.00	$364.32
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.90 / $69.29 / $129.57	Professional	26	$49.90	$69.29	$129.57
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $91.13 / $184.45 / $250.71	Professional	TC	$91.13	$184.45	$250.71
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $91.48 / $124.30 / $251.62	Professional		$91.48	$124.30	$251.62
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $41.52 / $64.65 / $91.60	Professional	26	$41.52	$64.65	$91.60
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $78.79 / $148.76 / $148.76	Professional	TC	$78.79	$148.76	$148.76
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $135.53 / $157.93 / $372.04	Professional		$135.53	$157.93	$372.04
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $48.99 / $55.12 / $130.34	Professional	26	$48.99	$55.12	$130.34
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $86.19 / $100.95 / $227.96	Professional	TC	$86.19	$100.95	$227.96
CareSource Facility/Professional Professional Modifier Low / Median / High Price $52.09 / $106.84 / $173.77	Professional		$52.09	$106.84	$173.77
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.64 / $58.64 / $58.64	Facility	26	$58.64	$58.64	$58.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $146.30 / $240.57 / $424.70	Professional		$146.30	$240.57	$424.70
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.74 / $81.53 / $152.69	Professional	26	$50.74	$81.53	$152.69
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $90.37 / $150.13 / $271.88	Professional	TC	$90.37	$150.13	$271.88
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $149.08 / $162.63 / $498.32	Professional		$149.08	$162.63	$498.32
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $54.27 / $71.05 / $181.40	Professional	26	$54.27	$71.05	$181.40
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $94.81 / $124.11 / $316.91	Professional	TC	$94.81	$124.11	$316.91
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $67.87 / $129.24 / $243.95	Professional		$67.87	$129.24	$243.95
United Facility/Professional Professional Modifier Low / Median / High Price $142.05 / $200.29 / $354.92	Professional		$142.05	$200.29	$354.92
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.02 / $68.39 / $121.78	Professional	26	$50.02	$68.39	$121.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $92.09 / $131.55 / $226.74	Professional	TC	$92.09	$131.55	$226.74