Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.00 / $142.30 / $482.91	Facility	26	$85.00	$142.30	$482.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $327.64 / $475.00 / $1,111.50	Professional		$327.64	$475.00	$1,111.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.00 / $165.71 / $348.94	Professional	26	$85.00	$165.71	$348.94
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $259.36 / $340.00 / $852.98	Professional	TC	$259.36	$340.00	$852.98
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $242.17 / $287.54 / $416.93	Professional		$242.17	$287.54	$416.93
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $80.98 / $148.63 / $196.02	Professional	26	$80.98	$148.63	$196.02
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $109.61 / $363.84 / $363.84	Professional	TC	$109.61	$363.84	$363.84
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $315.98 / $535.77 / $1,389.74	Professional		$315.98	$535.77	$1,389.74
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $99.69 / $141.74 / $296.42	Professional	26	$99.69	$141.74	$296.42
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $214.25 / $361.67 / $1,242.25	Professional	TC	$214.25	$361.67	$1,242.25
CareSource Facility/Professional Professional Modifier Low / Median / High Price $110.96 / $238.38 / $419.33	Professional		$110.96	$238.38	$419.33
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $124.22 / $124.22 / $124.22	Facility	26	$124.22	$124.22	$124.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $372.22 / $844.29 / $1,893.67	Professional		$372.22	$844.29	$1,893.67
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $108.20 / $184.40 / $306.63	Professional	26	$108.20	$184.40	$306.63
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $257.95 / $581.00 / $1,429.00	Professional	TC	$257.95	$581.00	$1,429.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $345.80 / $628.72 / $2,861.27	Professional		$345.80	$628.72	$2,861.27
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $116.14 / $185.15 / $403.37	Professional	26	$116.14	$185.15	$403.37
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 $152.04 / $315.26 / $581.57	Professional		$152.04	$315.26	$581.57
United Facility/Professional Professional Modifier Low / Median / High Price $353.61 / $633.78 / $1,466.55	Professional		$353.61	$633.78	$1,466.55
United Facility/Professional Professional Modifier 26 Low / Median / High Price $105.49 / $146.99 / $257.10	Professional	26	$105.49	$146.99	$257.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $233.89 / $412.63 / $1,072.40	Professional	TC	$233.89	$412.63	$1,072.40