Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $102.33 / $190.55 / $758.58	Facility		$102.33	$190.55	$758.58
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.88 / $21.88 / $37.15	Facility	26	$21.88	$21.88	$37.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $138.04 / $331.13	Professional		$104.71	$138.04	$331.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $24.55 / $51.29	Professional	26	$16.22	$24.55	$51.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $112.20 / $199.53	Professional	TC	$95.50	$112.20	$199.53
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $134.90 / $245.47	Professional		$107.15	$134.90	$245.47
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $28.84 / $43.65	Professional	26	$17.38	$28.84	$43.65
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $208.93 / $371.54	Professional		$134.90	$208.93	$371.54
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $22.39 / $41.69	Professional	26	$12.88	$22.39	$41.69
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $186.21 / $295.12	Professional	TC	$117.49	$186.21	$295.12
CareSource Facility/Professional Professional Modifier Low / Median / High Price $21.38 / $21.38 / $21.38	Professional		$21.38	$21.38	$21.38
Cigna Facility/Professional Facility Modifier Low / Median / High Price $251.19 / $251.19 / $251.19	Facility		$251.19	$251.19	$251.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $223.87 / $371.54	Professional		$141.25	$223.87	$371.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $25.12 / $53.70	Professional	26	$14.45	$25.12	$53.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $199.53 / $323.59	Professional	TC	$125.89	$199.53	$323.59
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $190.55 / $446.68	Professional		$147.91	$190.55	$446.68
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $29.51 / $60.26	Professional	26	$22.91	$29.51	$60.26
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $162.18 / $416.87	Professional	TC	$123.03	$162.18	$416.87
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $436.52 / $501.19	Professional		$151.36	$436.52	$501.19
United Facility/Professional Facility Modifier Low / Median / High Price $15.49 / $151.36 / $169.82	Facility		$15.49	$151.36	$169.82
United Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $199.53 / $331.13	Professional		$138.04	$199.53	$331.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $25.12 / $45.71	Professional	26	$13.49	$25.12	$45.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $177.83 / $288.40	Professional	TC	$117.49	$177.83	$288.40