Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.00 / $101.06 / $309.08	Facility	26	$85.00	$101.06	$309.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $280.82 / $465.02 / $842.08	Professional		$280.82	$465.02	$842.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.86 / $110.24 / $263.00	Professional	26	$68.86	$110.24	$263.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $125.00 / $212.50 / $404.06	Professional	52	$125.00	$212.50	$404.06
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $196.03 / $340.00 / $720.15	Professional	TC	$196.03	$340.00	$720.15
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $204.45 / $388.70	Professional		$173.78	$204.45	$388.70
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $56.28 / $94.12 / $124.15	Professional	26	$56.28	$94.12	$124.15
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $229.34 / $432.52 / $820.76	Professional		$229.34	$432.52	$820.76
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $64.33 / $89.96 / $185.65	Professional	26	$64.33	$89.96	$185.65
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $163.03 / $308.36 / $655.11	Professional	TC	$163.03	$308.36	$655.11
CareSource Facility/Professional Professional Modifier Low / Median / High Price $70.54 / $173.08 / $316.18	Professional		$70.54	$173.08	$316.18
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.45 / $79.45 / $79.45	Facility	26	$79.45	$79.45	$79.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $274.30 / $566.98 / $1,045.75	Professional		$274.30	$566.98	$1,045.75
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.86 / $113.10 / $203.40	Professional	26	$66.86	$113.10	$203.40
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $206.49 / $437.55 / $862.96	Professional	TC	$206.49	$437.55	$862.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $246.76 / $448.66 / $1,474.15	Professional		$246.76	$448.66	$1,474.15
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $73.56 / $113.71 / $257.04	Professional	26	$73.56	$113.71	$257.04
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $205.44 / $205.44 / $288.70	Professional	52	$205.44	$205.44	$288.70
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $173.21 / $314.92 / $1,331.01	Professional	TC	$173.21	$314.92	$1,331.01
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $96.65 / $234.89 / $415.01	Professional		$96.65	$234.89	$415.01
United Facility/Professional Professional Modifier Low / Median / High Price $254.45 / $474.16 / $809.83	Professional		$254.45	$474.16	$809.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.20 / $90.09 / $165.07	Professional	26	$66.20	$90.09	$165.07
United Facility/Professional Professional Modifier TC Low / Median / High Price $185.81 / $367.13 / $616.75	Professional	TC	$185.81	$367.13	$616.75