Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.00 / $63.24 / $422.01	Facility	26	$55.00	$63.24	$422.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $275.00 / $434.02 / $1,039.00	Professional		$275.00	$434.02	$1,039.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.00 / $107.34 / $279.17	Professional	26	$55.00	$107.34	$279.17
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $220.00 / $330.00 / $637.61	Professional	TC	$220.00	$330.00	$637.61
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $266.07 / $308.33 / $617.49	Professional		$266.07	$308.33	$617.49
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $75.84 / $115.99 / $170.58	Professional	26	$75.84	$115.99	$170.58
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $220.22 / $420.87 / $420.87	Professional	TC	$220.22	$420.87	$420.87
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $291.00 / $408.66 / $922.78	Professional		$291.00	$408.66	$922.78
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $84.85 / $115.45 / $253.49	Professional	26	$84.85	$115.45	$253.49
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $229.86 / $307.60 / $698.56	Professional	TC	$229.86	$307.60	$698.56
CareSource Facility/Professional Professional Modifier Low / Median / High Price $96.87 / $264.58 / $483.33	Professional		$96.87	$264.58	$483.33
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $108.46 / $108.46 / $108.46	Facility	26	$108.46	$108.46	$108.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $355.21 / $605.57 / $1,069.70	Professional		$355.21	$605.57	$1,069.70
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $94.36 / $152.24 / $275.23	Professional	26	$94.36	$152.24	$275.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $255.63 / $435.16 / $773.32	Professional	TC	$255.63	$435.16	$773.32
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $365.85 / $583.23 / $3,125.84	Professional		$365.85	$583.23	$3,125.84
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $101.07 / $161.12 / $762.22	Professional	26	$101.07	$161.12	$762.22
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $304.58 / $304.58 / $428.03	Professional	52	$304.58	$304.58	$428.03
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $264.77 / $422.11 / $2,317.98	Professional	TC	$264.77	$422.11	$2,317.98
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $119.44 / $347.91 / $575.47	Professional		$119.44	$347.91	$575.47
United Facility/Professional Professional Modifier Low / Median / High Price $340.53 / $516.99 / $848.89	Professional		$340.53	$516.99	$848.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $95.26 / $130.69 / $225.68	Professional	26	$95.26	$130.69	$225.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $248.10 / $386.56 / $650.49	Professional	TC	$248.10	$386.56	$650.49