Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.00 / $106.72 / $295.69	Facility	26	$55.00	$106.72	$295.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $267.77 / $355.71 / $1,080.88	Professional		$267.77	$355.71	$1,080.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.00 / $83.36 / $191.61	Professional	26	$55.00	$83.36	$191.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $187.20 / $253.82 / $689.44	Professional	TC	$187.20	$253.82	$689.44
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $195.19 / $227.52 / $447.55	Professional		$195.19	$227.52	$447.55
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $55.11 / $92.63 / $118.08	Professional	26	$55.11	$92.63	$118.08
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $212.29 / $212.29 / $212.29	Professional	TC	$212.29	$212.29	$212.29
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $241.01 / $366.08 / $776.12	Professional		$241.01	$366.08	$776.12
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $61.00 / $86.28 / $179.92	Professional	26	$61.00	$86.28	$179.92
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $179.36 / $267.45 / $597.19	Professional	TC	$179.36	$267.45	$597.19
CareSource Facility/Professional Professional Modifier Low / Median / High Price $67.25 / $210.30 / $384.07	Professional		$67.25	$210.30	$384.07
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.64 / $75.64 / $75.64	Facility	26	$75.64	$75.64	$75.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $266.41 / $526.00 / $888.26	Professional		$266.41	$526.00	$888.26
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.23 / $112.07 / $186.44	Professional	26	$64.23	$112.07	$186.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $195.15 / $381.78 / $712.33	Professional	TC	$195.15	$381.78	$712.33
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $280.41 / $509.84 / $1,245.34	Professional		$280.41	$509.84	$1,245.34
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $69.95 / $111.53 / $245.97	Professional	26	$69.95	$111.53	$245.97
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $210.45 / $382.64 / $1,060.04	Professional	TC	$210.45	$382.64	$1,060.04
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $86.45 / $245.10 / $465.37	Professional		$86.45	$245.10	$465.37
United Facility/Professional Professional Modifier Low / Median / High Price $266.20 / $436.96 / $782.22	Professional		$266.20	$436.96	$782.22
United Facility/Professional Professional Modifier 26 Low / Median / High Price $63.55 / $89.72 / $157.43	Professional	26	$63.55	$89.72	$157.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $194.36 / $317.22 / $610.80	Professional	TC	$194.36	$317.22	$610.80