Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.00 / $102.90 / $313.52	Facility	26	$85.00	$102.90	$313.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $213.32 / $425.00 / $1,108.32	Professional		$213.32	$425.00	$1,108.32
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.84 / $108.44 / $271.00	Professional	26	$67.84	$108.44	$271.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $117.18 / $212.50 / $563.63	Professional	52	$117.18	$212.50	$563.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $125.17 / $340.00 / $652.79	Professional	TC	$125.17	$340.00	$652.79
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $126.96 / $167.98 / $324.54	Professional		$126.96	$167.98	$324.54
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.21 / $88.88 / $125.95	Professional	26	$52.21	$88.88	$125.95
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $110.09 / $209.09 / $209.09	Professional	TC	$110.09	$209.09	$209.09
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $189.32 / $360.07 / $771.22	Professional		$189.32	$360.07	$771.22
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $66.70 / $95.02 / $190.98	Professional	26	$66.70	$95.02	$190.98
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $121.98 / $208.05 / $643.44	Professional	TC	$121.98	$208.05	$643.44
CareSource Facility/Professional Professional Modifier Low / Median / High Price $71.59 / $149.22 / $241.85	Professional		$71.59	$149.22	$241.85
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.59 / $80.59 / $80.59	Facility	26	$80.59	$80.59	$80.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $221.00 / $530.00 / $1,045.33	Professional		$221.00	$530.00	$1,045.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.73 / $120.90 / $210.97	Professional	26	$67.73	$120.90	$210.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $146.22 / $370.56 / $837.17	Professional	TC	$146.22	$370.56	$837.17
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $207.04 / $376.44 / $1,472.77	Professional		$207.04	$376.44	$1,472.77
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $74.62 / $118.96 / $261.91	Professional	26	$74.62	$118.96	$261.91
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $172.36 / $172.36 / $242.22	Professional	52	$172.36	$172.36	$242.22
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $132.41 / $240.76 / $1,305.08	Professional	TC	$132.41	$240.76	$1,305.08
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $97.22 / $183.89 / $348.21	Professional		$97.22	$183.89	$348.21
United Facility/Professional Professional Modifier Low / Median / High Price $209.50 / $389.44 / $831.59	Professional		$209.50	$389.44	$831.59
United Facility/Professional Professional Modifier 26 Low / Median / High Price $67.52 / $94.65 / $166.93	Professional	26	$67.52	$94.65	$166.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $134.58 / $240.84 / $595.10	Professional	TC	$134.58	$240.84	$595.10