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 / $367.01	Facility	26	$55.00	$68.75	$367.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $193.50 / $275.00 / $545.23	Professional		$193.50	$275.00	$545.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.00 / $85.44 / $284.83	Professional	26	$55.00	$85.44	$284.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $103.05 / $220.00 / $295.39	Professional	TC	$103.05	$220.00	$295.39
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $140.04 / $169.67 / $335.80	Professional		$140.04	$169.67	$335.80
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $64.16 / $111.93 / $147.63	Professional	26	$64.16	$111.93	$147.63
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $92.67 / $175.09 / $175.09	Professional	TC	$92.67	$175.09	$175.09
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $180.75 / $254.19 / $502.08	Professional		$180.75	$254.19	$502.08
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $78.59 / $107.28 / $220.47	Professional	26	$78.59	$107.28	$220.47
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $102.14 / $137.87 / $290.27	Professional	TC	$102.14	$137.87	$290.27
CareSource Facility/Professional Professional Modifier Low / Median / High Price $83.96 / $125.63 / $233.52	Professional		$83.96	$125.63	$233.52
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.15 / $94.15 / $94.15	Facility	26	$94.15	$94.15	$94.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $192.25 / $329.93 / $569.54	Professional		$192.25	$329.93	$569.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $82.10 / $134.80 / $246.26	Professional	26	$82.10	$134.80	$246.26
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $109.26 / $185.74 / $326.64	Professional	TC	$109.26	$185.74	$326.64
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $79.51 / $233.84 / $700.78	Professional		$79.51	$233.84	$700.78
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $79.51 / $114.51 / $306.20	Professional	26	$79.51	$114.51	$306.20
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $79.51 / $145.94 / $394.59	Professional	TC	$79.51	$145.94	$394.59
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $91.45 / $156.84 / $334.31	Professional		$91.45	$156.84	$334.31
United Facility/Professional Professional Modifier Low / Median / High Price $189.43 / $285.67 / $449.38	Professional		$189.43	$285.67	$449.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $82.53 / $112.70 / $195.43	Professional	26	$82.53	$112.70	$195.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $106.19 / $160.37 / $291.89	Professional	TC	$106.19	$160.37	$291.89