Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.15 / $95.50 / $190.55	Facility	26	$37.15	$95.50	$190.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $181.97 / $489.78	Professional		$91.20	$181.97	$489.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $74.13 / $218.78	Professional	26	$34.67	$74.13	$218.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $72.44 / $194.98	Professional	TC	$52.48	$72.44	$194.98
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $100.00 / $181.97	Professional		$77.62	$100.00	$181.97
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $41.69 / $72.44	Professional	26	$33.88	$41.69	$72.44
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $67.61 / $120.23	Professional	TC	$57.54	$67.61	$120.23
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $138.04 / $213.80	Professional		$91.20	$138.04	$213.80
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $54.95 / $83.18	Professional	26	$38.90	$54.95	$83.18
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $83.18 / $128.82	Professional	TC	$51.29	$83.18	$128.82
CareSource Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $72.44 / $134.90	Professional		$40.74	$72.44	$134.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $147.91 / $257.04	Professional		$93.33	$147.91	$257.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $58.88 / $104.71	Professional	26	$38.90	$58.88	$104.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $93.33 / $162.18	Professional	TC	$53.70	$93.33	$162.18
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $128.82 / $354.81	Professional		$112.20	$128.82	$354.81
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $50.12 / $154.88	Professional	26	$41.69	$50.12	$154.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $83.18 / $245.47	Professional	TC	$72.44	$83.18	$245.47
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $95.50 / $173.78	Professional		$43.65	$95.50	$173.78
United Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $128.82 / $239.88	Professional		$100.00	$128.82	$239.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $51.29 / $89.13	Professional	26	$39.81	$51.29	$89.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $81.28 / $151.36	Professional	TC	$57.54	$81.28	$151.36