Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.95 / $107.15 / $257.04	Facility	26	$54.95	$107.15	$257.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $263.03 / $616.60	Professional		$138.04	$263.03	$616.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $83.18 / $186.21	Professional	26	$52.48	$83.18	$186.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $162.18 / $338.84	Professional	TC	$81.28	$162.18	$338.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $109.65 / $229.09	Professional		$91.20	$109.65	$229.09
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $75.86 / $100.00	Professional	26	$45.71	$75.86	$100.00
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $102.33 / $102.33	Professional	TC	$102.33	$102.33	$102.33
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $275.42 / $457.09	Professional		$158.49	$275.42	$457.09
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $77.62 / $120.23	Professional	26	$57.54	$77.62	$120.23
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $173.78 / $338.84	Professional	TC	$93.33	$173.78	$338.84
CareSource Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $87.10 / $169.82	Professional		$57.54	$87.10	$169.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $288.40 / $524.81	Professional		$141.25	$288.40	$524.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $85.11 / $154.88	Professional	26	$51.29	$85.11	$154.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $190.55 / $371.54	Professional	TC	$87.10	$190.55	$371.54
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $181.97 / $741.31	Professional		$138.04	$181.97	$741.31
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $75.86 / $239.88	Professional	26	$54.95	$75.86	$239.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $107.15 / $741.31	Professional	TC	$83.18	$107.15	$741.31
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $120.23 / $239.88	Professional		$57.54	$120.23	$239.88
United Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $239.88 / $426.58	Professional		$138.04	$239.88	$426.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $70.79 / $131.83	Professional	26	$52.48	$70.79	$131.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $144.54 / $288.40	Professional	TC	$81.28	$144.54	$288.40