Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.00 / $175.90 / $524.00	Facility	26	$55.00	$175.90	$524.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $275.00 / $353.00 / $821.10	Professional		$275.00	$353.00	$821.10
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.00 / $92.07 / $317.79	Professional	26	$55.00	$92.07	$317.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $220.00 / $270.86 / $569.50	Professional	TC	$220.00	$270.86	$569.50
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $228.01 / $265.12 / $513.34	Professional		$228.01	$265.12	$513.34
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $66.95 / $122.04 / $160.06	Professional	26	$66.95	$122.04	$160.06
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $195.15 / $372.54 / $377.45	Professional	TC	$195.15	$372.54	$377.45
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $283.39 / $378.25 / $807.88	Professional		$283.39	$378.25	$807.88
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $77.39 / $105.69 / $231.17	Professional	26	$77.39	$105.69	$231.17
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $208.76 / $267.94 / $589.97	Professional	TC	$208.76	$267.94	$589.97
CareSource Facility/Professional Professional Modifier Low / Median / High Price $88.13 / $234.41 / $428.03	Professional		$88.13	$234.41	$428.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $98.40 / $98.40 / $98.40	Facility	26	$98.40	$98.40	$98.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $308.70 / $533.11 / $929.79	Professional		$308.70	$533.11	$929.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $86.05 / $137.26 / $249.33	Professional	26	$86.05	$137.26	$249.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $222.38 / $367.50 / $663.49	Professional	TC	$222.38	$367.50	$663.49
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $278.42 / $378.43 / $1,092.26	Professional		$278.42	$378.43	$1,092.26
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $92.18 / $146.94 / $319.77	Professional	26	$92.18	$146.94	$319.77
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $234.58 / $278.42 / $784.12	Professional	TC	$234.58	$278.42	$784.12
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $110.62 / $308.02 / $512.98	Professional		$110.62	$308.02	$512.98
United Facility/Professional Professional Modifier Low / Median / High Price $307.20 / $452.37 / $815.40	Professional		$307.20	$452.37	$815.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $84.07 / $118.10 / $206.86	Professional	26	$84.07	$118.10	$206.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $222.38 / $333.80 / $581.73	Professional	TC	$222.38	$333.80	$581.73