Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.00 / $119.52 / $265.99	Facility	26	$55.00	$119.52	$265.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $207.15 / $275.00 / $674.47	Professional		$207.15	$275.00	$674.47
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.56 / $55.00 / $141.04	Professional	26	$54.56	$55.00	$141.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $140.27 / $220.00 / $506.38	Professional	TC	$140.27	$220.00	$506.38
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $157.54 / $157.54 / $157.54	Professional		$157.54	$157.54	$157.54
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $71.68 / $71.68 / $93.39	Professional	26	$71.68	$71.68	$93.39
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $197.50 / $335.16 / $663.65	Professional		$197.50	$335.16	$663.65
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $55.01 / $78.31 / $159.76	Professional	26	$55.01	$78.31	$159.76
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $139.78 / $246.38 / $513.88	Professional	TC	$139.78	$246.38	$513.88
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $68.70 / $68.70 / $68.70	Facility	26	$68.70	$68.70	$68.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $250.39 / $473.37 / $822.52	Professional		$250.39	$473.37	$822.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.33 / $101.43 / $167.98	Professional	26	$58.33	$101.43	$167.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $192.50 / $350.70 / $639.54	Professional	TC	$192.50	$350.70	$639.54
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $213.00 / $387.28 / $1,088.96	Professional		$213.00	$387.28	$1,088.96
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $63.56 / $101.32 / $222.61	Professional	26	$63.56	$101.32	$222.61
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $149.44 / $271.70 / $1,079.70	Professional	TC	$149.44	$271.70	$1,079.70
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $82.99 / $200.13 / $355.90	Professional		$82.99	$200.13	$355.90
United Facility/Professional Professional Modifier Low / Median / High Price $227.14 / $395.73 / $672.77	Professional		$227.14	$395.73	$672.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.10 / $80.81 / $142.63	Professional	26	$58.10	$80.81	$142.63
United Facility/Professional Professional Modifier TC Low / Median / High Price $164.63 / $298.89 / $501.34	Professional	TC	$164.63	$298.89	$501.34