Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.95 / $83.18 / $218.78	Facility	26	$54.95	$83.18	$218.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $257.04 / $616.60	Professional		$131.83	$257.04	$616.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $64.57 / $186.21	Professional	26	$43.65	$64.57	$186.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $169.82 / $309.03	Professional	TC	$83.18	$169.82	$309.03
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $89.13 / $218.78	Professional		$85.11	$89.13	$218.78
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $50.12 / $79.43	Professional	26	$34.67	$50.12	$79.43
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $109.65 / $162.18	Professional	TC	$77.62	$109.65	$162.18
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $263.03 / $457.09	Professional		$154.88	$263.03	$457.09
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $72.44 / $114.82	Professional	26	$51.29	$72.44	$114.82
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $190.55 / $354.81	Professional	TC	$104.71	$190.55	$354.81
CareSource Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $91.20 / $162.18	Professional		$47.86	$91.20	$162.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $302.00 / $537.03	Professional		$158.49	$302.00	$537.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $75.86 / $141.25	Professional	26	$43.65	$75.86	$141.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $208.93 / $389.05	Professional	TC	$114.82	$208.93	$389.05
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $173.78 / $758.58	Professional		$131.83	$173.78	$758.58
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $63.10 / $234.42	Professional	26	$46.77	$63.10	$234.42
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $109.65 / $758.58	Professional	TC	$85.11	$109.65	$758.58
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $104.71 / $218.78	Professional		$48.98	$104.71	$218.78
United Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $257.04 / $436.52	Professional		$141.25	$257.04	$436.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $64.57 / $112.20	Professional	26	$46.77	$64.57	$112.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $181.97 / $309.03	Professional	TC	$95.50	$181.97	$309.03