Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.00 / $143.06 / $482.91	Facility	26	$85.00	$143.06	$482.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $326.61 / $475.00 / $1,972.45	Professional		$326.61	$475.00	$1,972.45
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.00 / $167.36 / $449.00	Professional	26	$85.00	$167.36	$449.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $163.31 / $212.50 / $881.06	Professional	52	$163.31	$212.50	$881.06
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $258.20 / $358.34 / $935.00	Professional	TC	$258.20	$358.34	$935.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $241.93 / $280.27 / $533.33	Professional		$241.93	$280.27	$533.33
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $84.14 / $153.33 / $195.43	Professional	26	$84.14	$153.33	$195.43
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $190.98 / $362.73 / $362.73	Professional	TC	$190.98	$362.73	$362.73
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $315.02 / $536.82 / $1,429.85	Professional		$315.02	$536.82	$1,429.85
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $99.63 / $141.30 / $298.66	Professional	26	$99.63	$141.30	$298.66
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $211.87 / $360.58 / $1,242.25	Professional	TC	$211.87	$360.58	$1,242.25
CareSource Facility/Professional Professional Modifier Low / Median / High Price $110.63 / $237.74 / $419.33	Professional		$110.63	$237.74	$419.33
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $123.88 / $123.88 / $123.88	Facility	26	$123.88	$123.88	$123.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $370.05 / $851.10 / $1,893.67	Professional		$370.05	$851.10	$1,893.67
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $108.20 / $183.58 / $329.47	Professional	26	$108.20	$183.58	$329.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $256.18 / $581.00 / $1,449.58	Professional	TC	$256.18	$581.00	$1,449.58
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $345.44 / $628.08 / $2,861.27	Professional		$345.44	$628.08	$2,861.27
Kaiser Permanente Facility/Professional Professional Modifier 22 Low / Median / High Price $986.04 / $986.04 / $1,385.64	Professional	22	$986.04	$986.04	$1,385.64
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $115.79 / $184.58 / $478.02	Professional	26	$115.79	$184.58	$478.02
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $287.60 / $287.60 / $404.15	Professional	52	$287.60	$287.60	$404.15
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $229.66 / $417.56 / $2,535.50	Professional	TC	$229.66	$417.56	$2,535.50
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $149.41 / $315.26 / $579.73	Professional		$149.41	$315.26	$579.73
United Facility/Professional Professional Modifier Low / Median / High Price $359.32 / $648.47 / $1,458.00	Professional		$359.32	$648.47	$1,458.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $106.85 / $144.25 / $259.83	Professional	26	$106.85	$144.25	$259.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $231.91 / $424.78 / $1,100.23	Professional	TC	$231.91	$424.78	$1,100.23