Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.00 / $68.75 / $460.62	Facility	26	$55.00	$68.75	$460.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $275.00 / $486.07 / $1,018.93	Professional		$275.00	$486.07	$1,018.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.00 / $119.06 / $377.75	Professional	26	$55.00	$119.06	$377.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $220.00 / $329.43 / $637.61	Professional	TC	$220.00	$329.43	$637.61
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $251.27 / $333.85 / $694.48	Professional		$251.27	$333.85	$694.48
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $80.94 / $146.84 / $192.41	Professional	26	$80.94	$146.84	$192.41
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $220.06 / $220.06 / $220.06	Professional	TC	$220.06	$220.06	$220.06
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $300.00 / $471.54 / $1,025.09	Professional		$300.00	$471.54	$1,025.09
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $75.70 / $122.95 / $243.40	Professional	26	$75.70	$122.95	$243.40
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $256.95 / $339.47 / $811.92	Professional	TC	$256.95	$339.47	$811.92
CareSource Facility/Professional Professional Modifier Low / Median / High Price $105.79 / $300.39 / $548.98	Professional		$105.79	$300.39	$548.98
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $118.52 / $118.52 / $118.52	Facility	26	$118.52	$118.52	$118.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $388.67 / $713.99 / $1,281.21	Professional		$388.67	$713.99	$1,281.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.42 / $165.66 / $305.29	Professional	26	$102.42	$165.66	$305.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $282.83 / $548.01 / $1,009.36	Professional	TC	$282.83	$548.01	$1,009.36
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $411.47 / $655.95 / $3,379.00	Professional		$411.47	$655.95	$3,379.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $110.81 / $176.66 / $642.01	Professional	26	$110.81	$176.66	$642.01
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $300.64 / $479.29 / $2,558.44	Professional	TC	$300.64	$479.29	$2,558.44
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $130.96 / $386.74 / $654.04	Professional		$130.96	$386.74	$654.04
United Facility/Professional Professional Modifier Low / Median / High Price $394.45 / $620.88 / $1,080.77	Professional		$394.45	$620.88	$1,080.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $100.62 / $140.10 / $245.97	Professional	26	$100.62	$140.10	$245.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $282.02 / $463.37 / $790.38	Professional	TC	$282.02	$463.37	$790.38