Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.00 / $102.74 / $313.52	Facility	26	$85.00	$102.74	$313.52
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $85.00 / $123.76 / $193.00	Facility	53	$85.00	$123.76	$193.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $218.80 / $425.00 / $1,102.13	Professional		$218.80	$425.00	$1,102.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.00 / $105.04 / $277.00	Professional	26	$68.00	$105.04	$277.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $120.07 / $212.50 / $556.66	Professional	52	$120.07	$212.50	$556.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $153.97 / $340.00 / $680.05	Professional	TC	$153.97	$340.00	$680.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $148.99 / $172.59 / $332.77	Professional		$148.99	$172.59	$332.77
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $55.72 / $95.06 / $125.36	Professional	26	$55.72	$95.06	$125.36
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $115.11 / $217.88 / $217.88	Professional	TC	$115.11	$217.88	$217.88
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $194.11 / $383.76 / $771.47	Professional		$194.11	$383.76	$771.47
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $65.55 / $92.59 / $190.05	Professional	26	$65.55	$92.59	$190.05
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $127.09 / $216.58 / $636.71	Professional	TC	$127.09	$216.58	$636.71
CareSource Facility/Professional Professional Modifier Low / Median / High Price $71.26 / $152.26 / $252.83	Professional		$71.26	$152.26	$252.83
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.26 / $80.26 / $80.26	Facility	26	$80.26	$80.26	$80.26
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $45.11 / $45.11 / $45.11	Facility	53	$45.11	$45.11	$45.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $226.29 / $530.00 / $1,016.28	Professional		$226.29	$530.00	$1,016.28
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.73 / $120.22 / $212.06	Professional	26	$67.73	$120.22	$212.06
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $151.91 / $390.01 / $870.94	Professional	TC	$151.91	$390.01	$870.94
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $212.72 / $386.76 / $1,490.66	Professional		$212.72	$386.76	$1,490.66
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $74.27 / $118.40 / $300.02	Professional	26	$74.27	$118.40	$300.02
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $177.09 / $177.09 / $248.86	Professional	52	$177.09	$177.09	$248.86
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $177.09 / $248.86 / $323.52	Professional	53	$177.09	$248.86	$323.52
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $138.44 / $251.72 / $1,293.79	Professional	TC	$138.44	$251.72	$1,293.79
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $96.43 / $190.05 / $357.02	Professional		$96.43	$190.05	$357.02
United Facility/Professional Professional Modifier Low / Median / High Price $218.17 / $405.75 / $888.66	Professional		$218.17	$405.75	$888.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $67.52 / $93.89 / $178.32	Professional	26	$67.52	$93.89	$178.32
United Facility/Professional Professional Modifier TC Low / Median / High Price $142.68 / $253.49 / $622.01	Professional	TC	$142.68	$253.49	$622.01