Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.00 / $68.75 / $210.99	Facility	26	$55.00	$68.75	$210.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $136.13 / $275.00 / $636.38	Professional		$136.13	$275.00	$636.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.08 / $65.67 / $180.98	Professional	26	$44.08	$65.67	$180.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $113.47 / $220.00 / $432.44	Professional	TC	$113.47	$220.00	$432.44
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $85.81 / $113.68 / $236.48	Professional		$85.81	$113.68	$236.48
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $34.61 / $57.30 / $86.75	Professional	26	$34.61	$57.30	$86.75
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $129.55 / $238.48 / $456.08	Professional		$129.55	$238.48	$456.08
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $45.42 / $68.56 / $130.22	Professional	26	$45.42	$68.56	$130.22
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $84.47 / $157.68 / $335.79	Professional	TC	$84.47	$157.68	$335.79
CareSource Facility/Professional Professional Modifier Low / Median / High Price $48.08 / $101.62 / $164.55	Professional		$48.08	$101.62	$164.55
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.02 / $54.02 / $54.02	Facility	26	$54.02	$54.02	$54.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $167.75 / $316.63 / $568.52	Professional		$167.75	$316.63	$568.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.33 / $83.34 / $143.77	Professional	26	$48.33	$83.34	$143.77
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $117.80 / $226.54 / $428.23	Professional	TC	$117.80	$226.54	$428.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $140.11 / $254.74 / $765.74	Professional		$140.11	$254.74	$765.74
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $49.96 / $83.51 / $233.91	Professional	26	$49.96	$83.51	$233.91
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $90.16 / $163.92 / $765.74	Professional	TC	$90.16	$163.92	$765.74
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $65.37 / $122.04 / $234.67	Professional		$65.37	$122.04	$234.67
United Facility/Professional Professional Modifier Low / Median / High Price $144.91 / $267.50 / $497.23	Professional		$144.91	$267.50	$497.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.06 / $68.56 / $112.33	Professional	26	$48.06	$68.56	$112.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $96.67 / $183.58 / $320.13	Professional	TC	$96.67	$183.58	$320.13