Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $478.63 / $501.19 / $1,000.00	Facility	TC	$478.63	$501.19	$1,000.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $102.33 / $323.59	Professional		$67.61	$102.33	$323.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $67.61 / $245.47	Professional	26	$25.70	$67.61	$245.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $63.10 / $186.21	Professional	TC	$43.65	$63.10	$186.21
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $56.23 / $208.93	Professional		$48.98	$56.23	$208.93
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $41.69 / $63.10	Professional	26	$17.38	$41.69	$63.10
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $35.48 / $125.89	Professional	TC	$34.67	$35.48	$125.89
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $102.33 / $208.93	Professional		$44.67	$102.33	$208.93
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $52.48 / $85.11	Professional	26	$16.22	$52.48	$85.11
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $58.88 / $114.82	Professional	TC	$29.51	$58.88	$114.82
CareSource Facility/Professional Facility Modifier Low / Median / High Price $45.71 / $97.72 / $208.93	Facility		$45.71	$97.72	$208.93
CareSource Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $83.18 / $138.04	Professional		$38.02	$83.18	$138.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $75.86 / $295.12	Professional		$48.98	$75.86	$295.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $34.67 / $89.13	Professional	26	$16.98	$34.67	$89.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $37.15 / $208.93	Professional	TC	$26.30	$37.15	$208.93
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $141.25 / $831.76	Professional		$72.44	$141.25	$831.76
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $50.12 / $275.42	Professional	26	$29.51	$50.12	$275.42
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $117.49 / $549.54	Professional	TC	$70.79	$117.49	$549.54
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $102.33 / $204.17	Professional		$34.67	$102.33	$204.17
United Facility/Professional Facility Modifier Low / Median / High Price $17.78 / $34.67 / $87.10	Facility		$17.78	$34.67	$87.10
United Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $107.15 / $239.88	Professional		$61.66	$107.15	$239.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $37.15 / $89.13	Professional	26	$21.88	$37.15	$89.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $64.57 / $162.18	Professional	TC	$38.90	$64.57	$162.18