Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.27 / $152.82 / $234.76	Facility	26	$45.27	$152.82	$234.76
Aetna Facility/Professional Professional Modifier Low / Median / High Price $168.01 / $195.86 / $473.47	Professional		$168.01	$195.86	$473.47
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.29 / $47.10 / $152.82	Professional	26	$42.29	$47.10	$152.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $126.24 / $150.59 / $354.00	Professional	TC	$126.24	$150.59	$354.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $75.16 / $75.16 / $75.16	Professional		$75.16	$75.16	$75.16
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $85.61 / $88.55 / $93.41	Professional	26	$85.61	$88.55	$93.41
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $198.80 / $265.12 / $573.64	Professional		$198.80	$265.12	$573.64
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $49.95 / $64.39 / $132.86	Professional	26	$49.95	$64.39	$132.86
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $148.85 / $200.82 / $401.66	Professional	TC	$148.85	$200.82	$401.66
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $59.80 / $59.80 / $59.80	Facility	26	$59.80	$59.80	$59.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $219.09 / $378.54 / $659.12	Professional		$219.09	$378.54	$659.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.93 / $85.49 / $156.47	Professional	26	$51.93	$85.49	$156.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $161.43 / $275.54 / $466.32	Professional	TC	$161.43	$275.54	$466.32
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $215.78 / $343.99 / $1,921.24	Professional		$215.78	$343.99	$1,921.24
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $55.34 / $72.45 / $184.95	Professional	26	$55.34	$72.45	$184.95
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $160.44 / $210.02 / $536.24	Professional	TC	$160.44	$210.02	$536.24
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $75.43 / $224.80 / $580.50	Professional		$75.43	$224.80	$580.50
United Facility/Professional Professional Modifier Low / Median / High Price $207.03 / $288.86 / $562.88	Professional		$207.03	$288.86	$562.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.60 / $71.50 / $129.41	Professional	26	$51.60	$71.50	$129.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $160.79 / $223.52 / $421.47	Professional	TC	$160.79	$223.52	$421.47