Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $229.09 / $501.19	Facility	26	$85.11	$229.09	$501.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $489.78 / $2,187.76	Professional		$331.13	$489.78	$2,187.76
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $186.21 / $467.74	Professional	26	$95.50	$186.21	$467.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $338.84 / $794.33	Professional	TC	$218.78	$338.84	$794.33
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $288.40 / $446.68	Professional		$251.19	$288.40	$446.68
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $107.15 / $194.98	Professional	26	$81.28	$107.15	$194.98
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $275.42 / $275.42	Professional	TC	$190.55	$275.42	$275.42
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $575.44 / $1,479.11	Professional		$371.54	$575.44	$1,479.11
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $151.36 / $257.04	Professional	26	$100.00	$151.36	$257.04
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $407.38 / $1,258.93	Professional	TC	$263.03	$407.38	$1,258.93
CareSource Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $229.09 / $398.11	Professional		$112.20	$229.09	$398.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $758.58 / $1,621.81	Professional		$354.81	$758.58	$1,621.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $173.78 / $295.12	Professional	26	$102.33	$173.78	$295.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $512.86 / $1,202.26	Professional	TC	$251.19	$512.86	$1,202.26
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $416.87 / $2,884.03	Professional		$323.59	$416.87	$2,884.03
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $144.54 / $389.05	Professional	26	$107.15	$144.54	$389.05
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $281.84 / $2,089.30	Professional	TC	$218.78	$281.84	$2,089.30
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $295.12 / $537.03	Professional		$112.20	$295.12	$537.03
United Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $630.96 / $1,318.26	Professional		$338.84	$630.96	$1,318.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $138.04 / $263.03	Professional	26	$104.71	$138.04	$263.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $416.87 / $1,023.29	Professional	TC	$229.09	$416.87	$1,023.29