Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $437.76 / $437.76 / $458.66	Facility	TC	$437.76	$437.76	$458.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $69.45 / $101.15 / $212.84	Professional		$69.45	$101.15	$212.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.85 / $140.32 / $753.18	Professional	26	$49.85	$140.32	$753.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.80 / $35.60 / $96.62	Professional	TC	$26.80	$35.60	$96.62
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $45.50 / $45.50 / $46.22	Professional		$45.50	$45.50	$46.22
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.04 / $64.91 / $111.26	Professional	26	$28.04	$64.91	$111.26
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $39.89 / $91.56 / $218.44	Professional		$39.89	$91.56	$218.44
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $26.64 / $61.84 / $142.29	Professional	26	$26.64	$61.84	$142.29
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $13.48 / $21.76 / $61.78	Professional	TC	$13.48	$21.76	$61.78
CareSource Facility/Professional Facility Modifier Low / Median / High Price $47.27 / $78.50 / $180.63	Facility		$47.27	$78.50	$180.63
CareSource Facility/Professional Professional Modifier Low / Median / High Price $36.24 / $58.25 / $111.05	Professional		$36.24	$58.25	$111.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $44.41 / $88.79 / $265.57	Professional		$44.41	$88.79	$265.57
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.12 / $58.99 / $158.44	Professional	26	$29.12	$58.99	$158.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $13.02 / $21.14 / $107.13	Professional	TC	$13.02	$21.14	$107.13
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $87.88 / $147.10 / $815.75	Professional		$87.88	$147.10	$815.75
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $52.43 / $87.76 / $486.95	Professional	26	$52.43	$87.76	$486.95
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $35.45 / $59.34 / $328.80	Professional	TC	$35.45	$59.34	$328.80
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $41.52 / $88.54 / $167.20	Professional		$41.52	$88.54	$167.20
United Facility/Professional Professional Modifier Low / Median / High Price $57.36 / $99.07 / $220.93	Professional		$57.36	$99.07	$220.93
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.72 / $65.28 / $134.91	Professional	26	$37.72	$65.28	$134.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.97 / $32.70 / $90.55	Professional	TC	$19.97	$32.70	$90.55