Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.31 / $65.81 / $228.83	Facility	26	$50.31	$65.81	$228.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $163.03 / $275.00 / $654.88	Professional		$163.03	$275.00	$654.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.66 / $62.15 / $188.00	Professional	26	$49.66	$62.15	$188.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $102.87 / $220.00 / $457.77	Professional	TC	$102.87	$220.00	$457.77
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $88.40 / $116.89 / $243.16	Professional		$88.40	$116.89	$243.16
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.08 / $69.92 / $92.20	Professional	26	$40.08	$69.92	$92.20
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $131.25 / $227.68 / $443.42	Professional		$131.25	$227.68	$443.42
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $49.30 / $68.22 / $142.38	Professional	26	$49.30	$68.22	$142.38
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $81.94 / $139.63 / $314.80	Professional	TC	$81.94	$139.63	$314.80
CareSource Facility/Professional Professional Modifier Low / Median / High Price $52.44 / $100.82 / $168.21	Professional		$52.44	$100.82	$168.21
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $59.04 / $59.04 / $59.04	Facility	26	$59.04	$59.04	$59.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $144.16 / $316.38 / $541.65	Professional		$144.16	$316.38	$541.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.03 / $86.91 / $155.43	Professional	26	$50.03	$86.91	$155.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $90.74 / $207.30 / $424.78	Professional	TC	$90.74	$207.30	$424.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $144.07 / $261.94 / $756.22	Professional		$144.07	$261.94	$756.22
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $54.63 / $87.08 / $220.62	Professional	26	$54.63	$87.08	$220.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $89.44 / $162.62 / $756.22	Professional	TC	$89.44	$162.62	$756.22
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $64.84 / $121.45 / $227.37	Professional		$64.84	$121.45	$227.37
United Facility/Professional Professional Modifier Low / Median / High Price $143.18 / $240.61 / $463.27	Professional		$143.18	$240.61	$463.27
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.99 / $70.20 / $122.59	Professional	26	$49.99	$70.20	$122.59
United Facility/Professional Professional Modifier TC Low / Median / High Price $87.43 / $143.11 / $289.37	Professional	TC	$87.43	$143.11	$289.37