Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $236.91 / $473.82 / $710.73	Facility	TC	$236.91	$473.82	$710.73
Aetna Facility/Professional Professional Modifier Low / Median / High Price $56.63 / $94.47 / $211.92	Professional		$56.63	$94.47	$211.92
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.47 / $47.25 / $212.31	Professional	26	$19.47	$47.25	$212.31
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $47.60 / $80.30 / $182.25	Professional	TC	$47.60	$80.30	$182.25
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $49.29 / $54.11 / $200.92	Professional		$49.29	$54.11	$200.92
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $12.06 / $24.23 / $46.05	Professional	26	$12.06	$24.23	$46.05
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $36.93 / $145.76 / $154.63	Professional	TC	$36.93	$145.76	$154.63
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $39.74 / $77.95 / $236.43	Professional		$39.74	$77.95	$236.43
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.23 / $26.97 / $60.54	Professional	26	$11.23	$26.97	$60.54
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $28.51 / $48.52 / $155.43	Professional	TC	$28.51	$48.52	$155.43
CareSource Facility/Professional Facility Modifier Low / Median / High Price $33.75 / $103.39 / $199.90	Facility		$33.75	$103.39	$199.90
CareSource Facility/Professional Professional Modifier Low / Median / High Price $24.19 / $83.29 / $120.47	Professional		$24.19	$83.29	$120.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $44.26 / $56.67 / $294.35	Professional		$44.26	$56.67	$294.35
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.83 / $25.68 / $67.80	Professional	26	$12.83	$25.68	$67.80
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $31.52 / $43.63 / $226.54	Professional	TC	$31.52	$43.63	$226.54
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $39.29 / $137.13 / $880.97	Professional		$39.29	$137.13	$880.97
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $22.44 / $37.56 / $209.46	Professional	26	$22.44	$37.56	$209.46
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $74.95 / $125.48 / $671.50	Professional	TC	$74.95	$125.48	$671.50
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $27.73 / $102.86 / $183.92	Professional		$27.73	$102.86	$183.92
United Facility/Professional Professional Modifier Low / Median / High Price $60.97 / $99.86 / $248.80	Professional		$60.97	$99.86	$248.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.14 / $27.81 / $57.32	Professional	26	$16.14	$27.81	$57.32
United Facility/Professional Professional Modifier TC Low / Median / High Price $43.41 / $71.48 / $187.37	Professional	TC	$43.41	$71.48	$187.37