Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $118.33 / $209.52 / $613.90	Professional		$118.33	$209.52	$613.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.03 / $52.58 / $250.29	Professional	26	$28.03	$52.58	$250.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $68.95 / $137.84 / $462.16	Professional	TC	$68.95	$137.84	$462.16
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $75.37 / $75.37 / $279.86	Professional		$75.37	$75.37	$279.86
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $17.48 / $40.49 / $63.78	Professional	26	$17.48	$40.49	$63.78
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $57.88 / $57.88 / $57.88	Professional	TC	$57.88	$57.88	$57.88
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $59.16 / $71.42 / $381.63	Professional		$59.16	$71.42	$381.63
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.42 / $16.42 / $87.27	Professional	26	$16.42	$16.42	$87.27
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $55.01 / $55.01 / $294.37	Professional	TC	$55.01	$55.01	$294.37
CareSource Facility/Professional Facility Modifier Low / Median / High Price $48.97 / $162.05 / $308.75	Facility		$48.97	$162.05	$308.75
CareSource Facility/Professional Professional Modifier Low / Median / High Price $35.20 / $130.65 / $185.57	Professional		$35.20	$130.65	$185.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $58.66 / $122.13 / $500.67	Professional		$58.66	$122.13	$500.67
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.39 / $26.46 / $99.29	Professional	26	$19.39	$26.46	$99.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $37.51 / $69.50 / $357.99	Professional	TC	$37.51	$69.50	$357.99
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $150.19 / $251.44 / $1,389.71	Professional		$150.19	$251.44	$1,389.71
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $32.61 / $54.60 / $299.36	Professional	26	$32.61	$54.60	$299.36
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $117.59 / $168.30 / $1,090.34	Professional	TC	$117.59	$168.30	$1,090.34
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $38.04 / $162.05 / $287.10	Professional		$38.04	$162.05	$287.10
United Facility/Professional Professional Modifier Low / Median / High Price $98.43 / $167.05 / $365.92	Professional		$98.43	$167.05	$365.92
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.74 / $40.76 / $83.92	Professional	26	$23.74	$40.76	$83.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $73.58 / $126.16 / $293.91	Professional	TC	$73.58	$126.16	$293.91