Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $87.45 / $111.47 / $262.51	Professional		$87.45	$111.47	$262.51
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.59 / $79.00 / $154.94	Professional	26	$67.59	$79.00	$154.94
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.87 / $31.11 / $56.39	Professional	TC	$19.87	$31.11	$56.39
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $95.60 / $162.35 / $193.94	Professional		$95.60	$162.35	$193.94
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $115.21 / $115.21 / $115.21	Professional	26	$115.21	$115.21	$115.21
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $78.55 / $119.40 / $221.54	Professional		$78.55	$119.40	$221.54
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $55.75 / $90.90 / $168.75	Professional	26	$55.75	$90.90	$168.75
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $21.28 / $32.83 / $67.04	Professional	TC	$21.28	$32.83	$67.04
CareSource Facility/Professional Professional Modifier Low / Median / High Price $27.10 / $101.86 / $126.11	Professional		$27.10	$101.86	$126.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.50 / $126.04 / $243.20	Professional		$81.50	$126.04	$243.20
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.05 / $97.99 / $205.76	Professional	26	$63.05	$97.99	$205.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.02 / $29.49 / $69.20	Professional	TC	$19.02	$29.49	$69.20
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $81.23 / $111.69 / $464.00	Professional		$81.23	$111.69	$464.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $58.75 / $80.78 / $385.12	Professional	26	$58.75	$80.78	$385.12
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $68.03 / $68.03 / $68.03	Professional	52	$68.03	$68.03	$68.03
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $22.48 / $30.91 / $78.88	Professional	TC	$22.48	$30.91	$78.88
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $27.10 / $90.82 / $178.30	Professional		$27.10	$90.82	$178.30
United Facility/Professional Professional Modifier Low / Median / High Price $82.30 / $104.12 / $171.69	Professional		$82.30	$104.12	$171.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.66 / $81.16 / $127.28	Professional	26	$64.66	$81.16	$127.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.48 / $25.06 / $43.64	Professional	TC	$17.48	$25.06	$43.64