Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $105.45 / $105.45 / $185.48	Facility	26	$105.45	$105.45	$185.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $352.28 / $543.08 / $897.24	Professional		$352.28	$543.08	$897.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $101.56 / $121.62 / $226.21	Professional	26	$101.56	$121.62	$226.21
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $150.02 / $344.97 / $397.42	Professional	52	$150.02	$344.97	$397.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $241.00 / $296.79 / $548.25	Professional	TC	$241.00	$296.79	$548.25
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $464.60 / $556.50 / $580.00	Professional		$464.60	$556.50	$580.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $168.00 / $168.00 / $168.00	Professional	26	$168.00	$168.00	$168.00
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $152.57 / $152.57 / $152.57	Professional	52	$152.57	$152.57	$152.57
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $318.00 / $318.00 / $318.00	Professional	TC	$318.00	$318.00	$318.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $336.07 / $475.18 / $938.87	Professional		$336.07	$475.18	$938.87
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $100.59 / $158.09 / $278.77	Professional	26	$100.59	$158.09	$278.77
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $254.65 / $341.38 / $674.53	Professional	TC	$254.65	$341.38	$674.53
CareSource Facility/Professional Professional Modifier Low / Median / High Price $128.80 / $272.08 / $459.70	Professional		$128.80	$272.08	$459.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $353.71 / $572.91 / $861.95	Professional		$353.71	$572.91	$861.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $119.83 / $177.74 / $275.08	Professional	26	$119.83	$177.74	$275.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $234.35 / $383.65 / $600.04	Professional	TC	$234.35	$383.65	$600.04
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $328.71 / $427.32 / $909.00	Professional		$328.71	$427.32	$909.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $99.65 / $129.55 / $336.33	Professional	26	$99.65	$129.55	$336.33
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $236.07 / $236.07 / $236.07	Professional	52	$236.07	$236.07	$236.07
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $229.06 / $297.77 / $572.66	Professional	TC	$229.06	$297.77	$572.66
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $165.42 / $344.55 / $545.66	Professional		$165.42	$344.55	$545.66
United Facility/Professional Professional Modifier Low / Median / High Price $335.52 / $453.96 / $772.29	Professional		$335.52	$453.96	$772.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $107.55 / $155.72 / $267.37	Professional	26	$107.55	$155.72	$267.37
United Facility/Professional Professional Modifier TC Low / Median / High Price $222.56 / $301.11 / $527.71	Professional	TC	$222.56	$301.11	$527.71