Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $186.21 / $501.19	Facility	26	$85.11	$186.21	$501.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $501.19 / $1,949.84	Professional		$323.59	$501.19	$1,949.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $177.83 / $457.09	Professional	26	$93.33	$177.83	$457.09
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 $194.98 / $275.42 / $426.58	Professional		$194.98	$275.42	$426.58
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $125.89 / $190.55	Professional	26	$83.18	$125.89	$190.55
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $190.55 / $363.08	Professional	TC	$162.18	$190.55	$363.08
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 $97.72 / $147.91 / $239.88	Professional	26	$97.72	$147.91	$239.88
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $426.58 / $1,288.25	Professional	TC	$263.03	$426.58	$1,288.25
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 / $1,659.59	Professional		$354.81	$758.58	$1,659.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $165.96 / $288.40	Professional	26	$102.33	$165.96	$288.40
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $524.81 / $1,258.93	Professional	TC	$251.19	$524.81	$1,258.93
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 / $1,348.96	Professional		$338.84	$630.96	$1,348.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $131.83 / $257.04	Professional	26	$102.33	$131.83	$257.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $416.87 / $1,071.52	Professional	TC	$229.09	$416.87	$1,071.52