Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.00 / $161.31 / $450.23	Facility	26	$85.00	$161.31	$450.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $243.44 / $475.00 / $1,155.39	Professional		$243.44	$475.00	$1,155.39
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.00 / $155.58 / $474.51	Professional	26	$85.00	$155.58	$474.51
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $289.57 / $348.53 / $860.22	Professional	TC	$289.57	$348.53	$860.22
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $256.76 / $302.07 / $438.00	Professional		$256.76	$302.07	$438.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $83.40 / $139.47 / $183.95	Professional	26	$83.40	$139.47	$183.95
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $333.52 / $568.35 / $1,345.23	Professional		$333.52	$568.35	$1,345.23
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $91.40 / $126.88 / $275.04	Professional	26	$91.40	$126.88	$275.04
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $240.29 / $407.85 / $1,206.50	Professional	TC	$240.29	$407.85	$1,206.50
CareSource Facility/Professional Professional Modifier Low / Median / High Price $104.16 / $255.35 / $466.51	Professional		$104.16	$255.35	$466.51
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $116.17 / $116.17 / $116.17	Facility	26	$116.17	$116.17	$116.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $395.62 / $880.05 / $1,832.94	Professional		$395.62	$880.05	$1,832.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $97.88 / $158.81 / $300.54	Professional	26	$97.88	$158.81	$300.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $290.33 / $727.17 / $1,446.38	Professional	TC	$290.33	$727.17	$1,446.38
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $364.54 / $662.80 / $2,780.50	Professional		$364.54	$662.80	$2,780.50
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $108.99 / $173.75 / $377.57	Professional	26	$108.99	$173.75	$377.57
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $255.55 / $464.64 / $2,463.91	Professional	TC	$255.55	$464.64	$2,463.91
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $143.22 / $348.48 / $612.70	Professional		$143.22	$348.48	$612.70
United Facility/Professional Professional Modifier Low / Median / High Price $391.19 / $713.17 / $1,322.75	Professional		$391.19	$713.17	$1,322.75
United Facility/Professional Professional Modifier 26 Low / Median / High Price $97.62 / $137.69 / $249.67	Professional	26	$97.62	$137.69	$249.67
United Facility/Professional Professional Modifier TC Low / Median / High Price $272.02 / $539.52 / $1,120.32	Professional	TC	$272.02	$539.52	$1,120.32