Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.00 / $105.55 / $219.45	Facility	26	$57.00	$105.55	$219.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $215.53 / $235.98 / $599.20	Professional		$215.53	$235.98	$599.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.00 / $68.39 / $170.25	Professional	26	$57.00	$68.39	$170.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $152.75 / $168.03 / $327.68	Professional	TC	$152.75	$168.03	$327.68
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $177.17 / $177.17 / $398.10	Professional		$177.17	$177.17	$398.10
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $108.18 / $137.61 / $137.61	Professional	26	$108.18	$137.61	$137.61
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $201.78 / $333.28 / $689.88	Professional		$201.78	$333.28	$689.88
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.87 / $100.37 / $193.04	Professional	26	$57.87	$100.37	$193.04
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $140.94 / $234.18 / $502.99	Professional	TC	$140.94	$234.18	$502.99
CareSource Facility/Professional Professional Modifier Low / Median / High Price $60.22 / $152.09 / $291.98	Professional		$60.22	$152.09	$291.98
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.50 / $69.50 / $69.50	Facility	26	$69.50	$69.50	$69.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $228.75 / $325.20 / $600.28	Professional		$228.75	$325.20	$600.28
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.43 / $97.43 / $168.03	Professional	26	$68.43	$97.43	$168.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $162.07 / $232.07 / $433.40	Professional	TC	$162.07	$232.07	$433.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $229.27 / $307.00 / $686.59	Professional		$229.27	$307.00	$686.59
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $64.17 / $87.51 / $190.78	Professional	26	$64.17	$87.51	$190.78
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $165.10 / $210.13 / $538.37	Professional	TC	$165.10	$210.13	$538.37
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $93.46 / $261.14 / $385.60	Professional		$93.46	$261.14	$385.60
United Facility/Professional Professional Modifier Low / Median / High Price $220.92 / $302.50 / $599.08	Professional		$220.92	$302.50	$599.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $63.46 / $85.67 / $166.93	Professional	26	$63.46	$85.67	$166.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $155.15 / $217.40 / $409.69	Professional	TC	$155.15	$217.40	$409.69