Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.00 / $101.82 / $309.08	Facility	26	$85.00	$101.82	$309.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $240.82 / $425.00 / $1,047.93	Professional		$240.82	$425.00	$1,047.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.28 / $111.02 / $309.10	Professional	26	$69.28	$111.02	$309.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $156.03 / $340.00 / $783.89	Professional	TC	$156.03	$340.00	$783.89
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $148.22 / $176.17 / $357.23	Professional		$148.22	$176.17	$357.23
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $56.03 / $87.25 / $123.56	Professional	26	$56.03	$87.25	$123.56
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $115.11 / $115.11 / $115.11	Professional	TC	$115.11	$115.11	$115.11
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $194.15 / $396.23 / $748.39	Professional		$194.15	$396.23	$748.39
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $66.06 / $90.80 / $190.77	Professional	26	$66.06	$90.80	$190.77
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $128.72 / $255.01 / $624.87	Professional	TC	$128.72	$255.01	$624.87
CareSource Facility/Professional Professional Modifier Low / Median / High Price $70.20 / $150.09 / $252.83	Professional		$70.20	$150.09	$252.83
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.09 / $79.09 / $79.09	Facility	26	$79.09	$79.09	$79.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $245.18 / $533.84 / $1,006.47	Professional		$245.18	$533.84	$1,006.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.20 / $120.00 / $203.40	Professional	26	$67.20	$120.00	$203.40
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $177.67 / $403.31 / $783.55	Professional	TC	$177.67	$403.31	$783.55
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $211.65 / $384.82 / $1,336.27	Professional		$211.65	$384.82	$1,336.27
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $73.20 / $116.70 / $255.81	Professional	26	$73.20	$116.70	$255.81
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $138.44 / $251.72 / $1,247.95	Professional	TC	$138.44	$251.72	$1,247.95
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $93.17 / $189.63 / $354.63	Professional		$93.17	$189.63	$354.63
United Facility/Professional Professional Modifier Low / Median / High Price $212.46 / $411.86 / $769.78	Professional		$212.46	$411.86	$769.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.20 / $92.80 / $164.55	Professional	26	$66.20	$92.80	$164.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $146.05 / $288.88 / $549.08	Professional	TC	$146.05	$288.88	$549.08