Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $114.82 / $323.59	Facility	26	$85.11	$114.82	$323.59
Aetna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $426.58 / $1,202.26	Professional		$194.98	$426.58	$1,202.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $117.49 / $288.40	Professional	26	$66.07	$117.49	$288.40
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $123.03 / $199.53 / $870.96	Professional	52	$123.03	$199.53	$870.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $275.42 / $575.44	Professional	TC	$112.20	$275.42	$575.44
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $199.53 / $316.23	Professional		$144.54	$199.53	$316.23
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $72.44 / $125.89	Professional	26	$54.95	$72.44	$125.89
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $104.71 / $158.49	Professional	TC	$79.43	$104.71	$158.49
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $467.74 / $794.33	Professional		$218.78	$467.74	$794.33
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $104.71 / $162.18	Professional	26	$74.13	$104.71	$162.18
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $316.23 / $645.65	Professional	TC	$147.91	$316.23	$645.65
CareSource Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $131.83 / $239.88	Professional		$72.44	$131.83	$239.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $489.78 / $933.25	Professional		$213.80	$489.78	$933.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $112.20 / $204.17	Professional	26	$66.07	$112.20	$204.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $316.23 / $758.58	Professional	TC	$141.25	$316.23	$758.58
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $251.19 / $1,380.38	Professional		$194.98	$251.19	$1,380.38
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $93.33 / $251.19	Professional	26	$69.18	$93.33	$251.19
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $169.82 / $169.82 / $239.88	Professional	52	$169.82	$169.82	$239.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $162.18 / $1,174.90	Professional	TC	$125.89	$162.18	$1,174.90
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $173.78 / $323.59	Professional		$72.44	$173.78	$323.59
United Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $371.54 / $741.31	Professional		$199.53	$371.54	$741.31
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $89.13 / $165.96	Professional	26	$69.18	$89.13	$165.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $234.42 / $549.54	Professional	TC	$128.82	$234.42	$549.54