Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.90 / $61.72 / $209.50	Facility	26	$40.90	$61.72	$209.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $113.66 / $194.73 / $366.50	Professional		$113.66	$194.73	$366.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.25 / $61.72 / $120.12	Professional	26	$40.25	$61.72	$120.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $71.09 / $94.80 / $210.33	Professional	TC	$71.09	$94.80	$210.33
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $101.18 / $160.69 / $228.78	Professional		$101.18	$160.69	$228.78
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $37.68 / $77.23 / $84.92	Professional	26	$37.68	$77.23	$84.92
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $80.68 / $83.35 / $142.68	Professional	TC	$80.68	$83.35	$142.68
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $118.04 / $175.65 / $317.07	Professional		$118.04	$175.65	$317.07
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $41.38 / $62.34 / $115.85	Professional	26	$41.38	$62.34	$115.85
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $74.97 / $111.73 / $207.66	Professional	TC	$74.97	$111.73	$207.66
CareSource Facility/Professional Professional Modifier Low / Median / High Price $47.06 / $96.28 / $169.44	Professional		$47.06	$96.28	$169.44
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.96 / $53.96 / $53.96	Facility	26	$53.96	$53.96	$53.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $127.79 / $202.79 / $349.12	Professional		$127.79	$202.79	$349.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.94 / $71.34 / $126.19	Professional	26	$47.94	$71.34	$126.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $84.31 / $131.80 / $227.45	Professional	TC	$84.31	$131.80	$227.45
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $129.99 / $166.66 / $416.33	Professional		$129.99	$166.66	$416.33
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $45.74 / $59.46 / $147.06	Professional	26	$45.74	$59.46	$147.06
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $84.26 / $104.58 / $357.79	Professional	TC	$84.26	$104.58	$357.79
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $47.73 / $105.35 / $209.74	Professional		$47.73	$105.35	$209.74
United Facility/Professional Professional Modifier Low / Median / High Price $133.76 / $185.04 / $302.16	Professional		$133.76	$185.04	$302.16
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.29 / $62.84 / $104.28	Professional	26	$47.29	$62.84	$104.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $82.34 / $111.94 / $194.98	Professional	TC	$82.34	$111.94	$194.98