Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.91 / $56.23 / $123.03	Facility	26	$22.91	$56.23	$123.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $128.82 / $436.52	Professional		$81.28	$128.82	$436.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $34.67 / $107.15	Professional	26	$21.88	$34.67	$107.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $79.43 / $177.83	Professional	TC	$58.88	$79.43	$177.83
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $95.50 / $190.55	Professional		$69.18	$95.50	$190.55
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $36.31 / $46.77	Professional	26	$20.89	$36.31	$46.77
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $57.54 / $57.54	Professional	TC	$57.54	$57.54	$57.54
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $112.20 / $186.21	Professional		$87.10	$112.20	$186.21
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $33.11 / $48.98	Professional	26	$26.92	$33.11	$48.98
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $81.28 / $134.90	Professional	TC	$60.26	$81.28	$134.90
CareSource Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $83.18 / $120.23	Professional		$26.30	$83.18	$120.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $138.04 / $251.19	Professional		$93.33	$138.04	$251.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $38.02 / $69.18	Professional	26	$25.70	$38.02	$69.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $97.72 / $190.55	Professional	TC	$67.61	$97.72	$190.55
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $123.03 / $398.11	Professional		$107.15	$123.03	$398.11
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $30.20 / $91.20	Professional	26	$26.30	$30.20	$91.20
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $93.33 / $239.88	Professional	TC	$81.28	$93.33	$239.88
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $117.49 / $295.12	Professional		$38.02	$117.49	$295.12
United Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $125.89 / $234.42	Professional		$95.50	$125.89	$234.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $34.67 / $57.54	Professional	26	$25.70	$34.67	$57.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $93.33 / $177.83	Professional	TC	$67.61	$93.33	$177.83