Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.92 / $90.11 / $190.18	Facility	26	$58.92	$90.11	$190.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $234.46 / $339.01 / $393.38	Professional		$234.46	$339.01	$393.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $73.95 / $89.24 / $140.79	Professional	26	$73.95	$89.24	$140.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $149.49 / $256.31 / $322.02	Professional	TC	$149.49	$256.31	$322.02
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $107.96 / $121.54 / $177.99	Professional		$107.96	$121.54	$177.99
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $42.43 / $63.56 / $78.66	Professional	26	$42.43	$63.56	$78.66
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $111.43 / $182.33 / $341.03	Professional		$111.43	$182.33	$341.03
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $39.69 / $58.22 / $114.25	Professional	26	$39.69	$58.22	$114.25
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $68.64 / $103.98 / $226.24	Professional	TC	$68.64	$103.98	$226.24
CareSource Facility/Professional Professional Modifier Low / Median / High Price $44.25 / $98.12 / $242.00	Professional		$44.25	$98.12	$242.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $127.33 / $202.98 / $723.14	Professional		$127.33	$202.98	$723.14
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $48.52 / $77.34 / $185.61	Professional	26	$48.52	$77.34	$185.61
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $78.80 / $125.63 / $723.14	Professional	TC	$78.80	$125.63	$723.14
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $64.64 / $118.85 / $214.14	Professional		$64.64	$118.85	$214.14
United Facility/Professional Professional Modifier Low / Median / High Price $116.73 / $174.48 / $291.58	Professional		$116.73	$174.48	$291.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.26 / $53.88 / $101.25	Professional	26	$39.26	$53.88	$101.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $71.70 / $121.15 / $206.75	Professional	TC	$71.70	$121.15	$206.75