Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.95 / $102.33 / $251.19	Facility	26	$54.95	$102.33	$251.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $223.87 / $512.86	Professional		$114.82	$223.87	$512.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $91.20 / $245.47	Professional	26	$51.29	$91.20	$245.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $218.78 / $338.84	Professional	TC	$114.82	$218.78	$338.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $147.91 / $147.91	Professional		$147.91	$147.91	$147.91
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $66.07 / $100.00	Professional	26	$41.69	$66.07	$100.00
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $102.33 / $144.54	Professional	TC	$102.33	$102.33	$144.54
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $302.00 / $501.19	Professional		$199.53	$302.00	$501.19
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $75.86 / $120.23	Professional	26	$50.12	$75.86	$120.23
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $218.78 / $389.05	Professional	TC	$138.04	$218.78	$389.05
CareSource Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $123.03 / $208.93	Professional		$56.23	$123.03	$208.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $354.81 / $588.84	Professional		$194.98	$354.81	$588.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $83.18 / $147.91	Professional	26	$50.12	$83.18	$147.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $251.19 / $457.09	Professional	TC	$147.91	$251.19	$457.09
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $218.78 / $812.83	Professional		$169.82	$218.78	$812.83
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $74.13 / $194.98	Professional	26	$53.70	$74.13	$194.98
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $147.91 / $758.58	Professional	TC	$114.82	$147.91	$758.58
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $154.88 / $275.42	Professional		$56.23	$154.88	$275.42
United Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $295.12 / $512.86	Professional		$177.83	$295.12	$512.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $69.18 / $128.82	Professional	26	$51.29	$69.18	$128.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $218.78 / $363.08	Professional	TC	$123.03	$218.78	$363.08