Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $102.80 / $261.70 / $751.90	Facility		$102.80	$261.70	$751.90
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.94 / $21.94 / $38.53	Facility	26	$21.94	$21.94	$38.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $103.81 / $129.63 / $320.19	Professional		$103.81	$129.63	$320.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.77 / $23.79 / $50.68	Professional	26	$11.77	$23.79	$50.68
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $92.88 / $105.50 / $244.70	Professional	TC	$92.88	$105.50	$244.70
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $134.93 / $168.30 / $227.45	Professional		$134.93	$168.30	$227.45
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $26.00 / $35.51 / $41.35	Professional	26	$26.00	$35.51	$41.35
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $120.96 / $206.96 / $372.78	Professional		$120.96	$206.96	$372.78
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $15.04 / $26.12 / $48.99	Professional	26	$15.04	$26.12	$48.99
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $102.50 / $176.87 / $325.08	Professional	TC	$102.50	$176.87	$325.08
CareSource Facility/Professional Facility Modifier Low / Median / High Price $18.11 / $133.26 / $151.37	Facility		$18.11	$133.26	$151.37
CareSource Facility/Professional Professional Modifier Low / Median / High Price $21.37 / $21.37 / $21.37	Professional		$21.37	$21.37	$21.37
Cigna Facility/Professional Facility Modifier Low / Median / High Price $147.68 / $147.68 / $251.87	Facility		$147.68	$147.68	$251.87
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.75 / $26.75 / $26.75	Facility	26	$26.75	$26.75	$26.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $139.83 / $221.79 / $363.73	Professional		$139.83	$221.79	$363.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.82 / $25.03 / $52.57	Professional	26	$13.82	$25.03	$52.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $120.61 / $200.62 / $324.91	Professional	TC	$120.61	$200.62	$324.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $140.43 / $182.56 / $446.06	Professional		$140.43	$182.56	$446.06
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $22.27 / $28.95 / $56.12	Professional	26	$22.27	$28.95	$56.12
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $118.16 / $153.61 / $417.17	Professional	TC	$118.16	$153.61	$417.17
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $34.22 / $185.38 / $455.40	Professional		$34.22	$185.38	$455.40
United Facility/Professional Professional Modifier Low / Median / High Price $137.83 / $197.71 / $324.12	Professional		$137.83	$197.71	$324.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.89 / $25.60 / $45.28	Professional	26	$13.89	$25.60	$45.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $115.54 / $172.65 / $290.20	Professional	TC	$115.54	$172.65	$290.20