Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $514.51 / $2,058.03 / $4,630.58	Facility	TC	$514.51	$2,058.03	$4,630.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $63.87 / $112.93 / $706.16	Professional		$63.87	$112.93	$706.16
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.44 / $95.55 / $776.20	Professional	26	$25.44	$95.55	$776.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.12 / $79.23 / $235.68	Professional	TC	$43.12	$79.23	$235.68
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $42.37 / $86.89 / $131.35	Professional		$42.37	$86.89	$131.35
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $29.62 / $48.94	Professional	26	$12.88	$29.62	$48.94
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $29.56 / $29.56 / $90.00	Professional	TC	$29.56	$29.56	$90.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $37.86 / $51.93 / $200.90	Professional		$37.86	$51.93	$200.90
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.95 / $16.71 / $59.98	Professional	26	$11.95	$16.71	$59.98
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $25.92 / $35.21 / $140.50	Professional	TC	$25.92	$35.21	$140.50
CareSource Facility/Professional Facility Modifier Low / Median / High Price $35.86 / $82.77 / $160.22	Facility		$35.86	$82.77	$160.22
CareSource Facility/Professional Professional Modifier Low / Median / High Price $25.73 / $66.76 / $104.17	Professional		$25.73	$66.76	$104.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.90 / $70.56 / $279.89	Professional		$33.90	$70.56	$279.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.08 / $19.60 / $72.72	Professional	26	$11.08	$19.60	$72.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.31 / $33.38 / $182.91	Professional	TC	$22.31	$33.38	$182.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $83.97 / $118.64 / $731.64	Professional		$83.97	$118.64	$731.64
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $23.89 / $39.99 / $223.05	Professional	26	$23.89	$39.99	$223.05
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $60.08 / $84.74 / $508.59	Professional	TC	$60.08	$84.74	$508.59
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $29.46 / $87.81 / $156.74	Professional		$29.46	$87.81	$156.74
United Facility/Professional Professional Modifier Low / Median / High Price $52.77 / $92.31 / $190.51	Professional		$52.77	$92.31	$190.51
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.18 / $28.68 / $61.02	Professional	26	$17.18	$28.68	$61.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $35.47 / $62.51 / $150.18	Professional	TC	$35.47	$62.51	$150.18