Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.00 / $108.56 / $368.49	Facility	26	$55.00	$108.56	$368.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $265.26 / $347.14 / $1,077.40	Professional		$265.26	$347.14	$1,077.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.00 / $84.05 / $258.27	Professional	26	$55.00	$84.05	$258.27
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $192.00 / $264.00 / $882.03	Professional	TC	$192.00	$264.00	$882.03
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $121.31 / $282.97 / $478.37	Professional		$121.31	$282.97	$478.37
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $58.13 / $104.64 / $152.49	Professional	26	$58.13	$104.64	$152.49
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $250.22 / $387.99 / $884.58	Professional		$250.22	$387.99	$884.58
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $60.40 / $107.71 / $225.69	Professional	26	$60.40	$107.71	$225.69
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $179.36 / $277.75 / $697.87	Professional	TC	$179.36	$277.75	$697.87
CareSource Facility/Professional Professional Modifier Low / Median / High Price $84.32 / $211.03 / $385.71	Professional		$84.32	$211.03	$385.71
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 $290.29 / $612.14 / $1,157.41	Professional		$290.29	$612.14	$1,157.41
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $80.81 / $135.36 / $249.91	Professional	26	$80.81	$135.36	$249.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $206.38 / $470.43 / $983.72	Professional	TC	$206.38	$470.43	$983.72
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $299.04 / $513.44 / $1,697.80	Professional		$299.04	$513.44	$1,697.80
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 $211.21 / $382.86 / $1,462.24	Professional	TC	$211.21	$382.86	$1,462.24
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $116.99 / $283.13 / $489.33	Professional		$116.99	$283.13	$489.33
United Facility/Professional Professional Modifier Low / Median / High Price $285.20 / $480.80 / $902.88	Professional		$285.20	$480.80	$902.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $79.42 / $111.59 / $196.24	Professional	26	$79.42	$111.59	$196.24
United Facility/Professional Professional Modifier TC Low / Median / High Price $197.49 / $366.99 / $703.00	Professional	TC	$197.49	$366.99	$703.00