Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.00 / $108.62 / $368.49	Facility	26	$55.00	$108.62	$368.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $257.67 / $340.12 / $1,077.40	Professional		$257.67	$340.12	$1,077.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.00 / $85.50 / $258.27	Professional	26	$55.00	$85.50	$258.27
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $192.00 / $270.97 / $653.60	Professional	TC	$192.00	$270.97	$653.60
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $173.33 / $279.86 / $478.37	Professional		$173.33	$279.86	$478.37
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $65.88 / $116.27 / $152.49	Professional	26	$65.88	$116.27	$152.49
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $250.22 / $388.92 / $885.63	Professional		$250.22	$388.92	$885.63
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $60.40 / $107.71 / $221.36	Professional	26	$60.40	$107.71	$221.36
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $179.66 / $276.77 / $684.55	Professional	TC	$179.66	$276.77	$684.55
CareSource Facility/Professional Professional Modifier Low / Median / High Price $84.32 / $211.39 / $386.37	Professional		$84.32	$211.39	$386.37
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.56 / $94.56 / $94.56	Facility	26	$94.56	$94.56	$94.56
Cigna Facility/Professional Professional Modifier Low / Median / High Price $287.30 / $578.64 / $1,152.31	Professional		$287.30	$578.64	$1,152.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $80.47 / $135.36 / $249.91	Professional	26	$80.47	$135.36	$249.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $207.09 / $451.78 / $951.73	Professional	TC	$207.09	$451.78	$951.73
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $299.39 / $513.44 / $1,690.21	Professional		$299.39	$513.44	$1,690.21
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $87.82 / $140.01 / $339.52	Professional	26	$87.82	$140.01	$339.52
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $211.56 / $382.86 / $1,455.58	Professional	TC	$211.56	$382.86	$1,455.58
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $113.76 / $265.89 / $489.92	Professional		$113.76	$265.89	$489.92
United Facility/Professional Professional Modifier Low / Median / High Price $282.61 / $475.54 / $956.46	Professional		$282.61	$475.54	$956.46
United Facility/Professional Professional Modifier 26 Low / Median / High Price $80.50 / $111.63 / $196.24	Professional	26	$80.50	$111.63	$196.24
United Facility/Professional Professional Modifier TC Low / Median / High Price $207.30 / $373.79 / $732.25	Professional	TC	$207.30	$373.79	$732.25