Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $632.00 / $3,391.00 / $6,915.00	Facility		$632.00	$3,391.00	$6,915.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $128.43 / $128.43 / $224.67	Facility	26	$128.43	$128.43	$224.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $370.30 / $483.86 / $963.63	Professional		$370.30	$483.86	$963.63
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $124.31 / $150.47 / $276.31	Professional	26	$124.31	$150.47	$276.31
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $244.07 / $297.16 / $527.16	Professional	TC	$244.07	$297.16	$527.16
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $325.64 / $592.72 / $647.14	Professional		$325.64	$592.72	$647.14
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $219.51 / $219.51 / $219.51	Professional	26	$219.51	$219.51	$219.51
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $7,875.00 / $7,875.00 / $7,875.00	Facility		$7,875.00	$7,875.00	$7,875.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $357.11 / $509.68 / $991.35	Professional		$357.11	$509.68	$991.35
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $122.15 / $190.56 / $339.52	Professional	26	$122.15	$190.56	$339.52
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $255.09 / $339.26 / $670.37	Professional	TC	$255.09	$339.26	$670.37
CareSource Facility/Professional Facility Modifier Low / Median / High Price $165.52 / $281.44 / $478.88	Facility		$165.52	$281.44	$478.88
CareSource Facility/Professional Professional Modifier Low / Median / High Price $276.99 / $455.53 / $732.53	Professional		$276.99	$455.53	$732.53
Cigna Facility/Professional Facility Modifier Low / Median / High Price $286.02 / $286.02 / $286.02	Facility		$286.02	$286.02	$286.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $382.17 / $614.47 / $931.31	Professional		$382.17	$614.47	$931.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $144.53 / $215.40 / $334.04	Professional	26	$144.53	$215.40	$334.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $237.90 / $388.99 / $599.29	Professional	TC	$237.90	$388.99	$599.29
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $348.56 / $453.13 / $1,738.00	Professional		$348.56	$453.13	$1,738.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $121.72 / $158.24 / $643.05	Professional	26	$121.72	$158.24	$643.05
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $226.84 / $294.89 / $1,094.94	Professional	TC	$226.84	$294.89	$1,094.94
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $202.06 / $338.29 / $578.61	Professional		$202.06	$338.29	$578.61
United Facility/Professional Facility Modifier Low / Median / High Price $424.00 / $2,360.00 / $4,066.00	Facility		$424.00	$2,360.00	$4,066.00
United Facility/Professional Professional Modifier Low / Median / High Price $363.36 / $480.59 / $825.92	Professional		$363.36	$480.59	$825.92
United Facility/Professional Professional Modifier 26 Low / Median / High Price $131.99 / $187.51 / $294.98	Professional	26	$131.99	$187.51	$294.98
United Facility/Professional Professional Modifier TC Low / Median / High Price $226.32 / $311.68 / $530.94	Professional	TC	$226.32	$311.68	$530.94