Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.95 / $125.89 / $302.00	Facility	26	$54.95	$125.89	$302.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $323.59 / $1,047.13	Professional		$223.87	$323.59	$1,047.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $91.20 / $223.87	Professional	26	$54.95	$91.20	$223.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $239.88 / $602.56	Professional	TC	$158.49	$239.88	$602.56
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $288.40 / $426.58	Professional		$208.93	$288.40	$426.58
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $75.86 / $114.82	Professional	26	$50.12	$75.86	$114.82
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $162.18 / $338.84	Professional	TC	$138.04	$162.18	$338.84
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $371.54 / $707.95	Professional		$251.19	$371.54	$707.95
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $91.20 / $151.36	Professional	26	$52.48	$91.20	$151.36
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $288.40 / $562.34	Professional	TC	$199.53	$288.40	$562.34
CareSource Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $208.93 / $323.59	Professional		$67.61	$208.93	$323.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $489.78 / $851.14	Professional		$263.03	$489.78	$851.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $100.00 / $177.83	Professional	26	$60.26	$100.00	$177.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $354.81 / $691.83	Professional	TC	$194.98	$354.81	$691.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $338.84 / $1,096.48	Professional		$263.03	$338.84	$1,096.48
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $87.10 / $234.42	Professional	26	$64.57	$87.10	$234.42
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $257.04 / $1,071.52	Professional	TC	$199.53	$257.04	$1,071.52
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $218.78 / $436.52	Professional		$66.07	$218.78	$436.52
United Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $416.87 / $741.31	Professional		$257.04	$416.87	$741.31
United Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $83.18 / $154.88	Professional	26	$63.10	$83.18	$154.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $316.23 / $602.56	Professional	TC	$190.55	$316.23	$602.56