Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.95 / $218.78 / $512.86	Facility	26	$54.95	$218.78	$512.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $363.08 / $1,000.00	Professional		$263.03	$363.08	$1,000.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $151.36 / $363.08	Professional	26	$60.26	$151.36	$363.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $229.09 / $562.34	Professional	TC	$158.49	$229.09	$562.34
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $354.81 / $489.78	Professional		$194.98	$354.81	$489.78
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $131.83 / $199.53	Professional	26	$85.11	$131.83	$199.53
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $295.12 / $389.05	Professional	TC	$186.21	$295.12	$389.05
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $501.19 / $1,122.02	Professional		$251.19	$501.19	$1,122.02
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $151.36 / $239.88	Professional	26	$77.62	$151.36	$239.88
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $363.08 / $891.25	Professional	TC	$194.98	$363.08	$891.25
CareSource Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $323.59 / $512.86	Professional		$114.82	$323.59	$512.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $724.44 / $1,288.25	Professional		$371.54	$724.44	$1,288.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $162.18 / $295.12	Professional	26	$97.72	$162.18	$295.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $524.81 / $977.24	Professional	TC	$263.03	$524.81	$977.24
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $549.54 / $1,905.46	Professional		$416.87	$549.54	$1,905.46
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $151.36 / $398.11	Professional	26	$112.20	$151.36	$398.11
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $309.03 / $398.11 / $1,905.46	Professional	TC	$309.03	$398.11	$1,905.46
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $323.59 / $691.83	Professional		$114.82	$323.59	$691.83
United Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $630.96 / $1,071.52	Professional		$389.05	$630.96	$1,071.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $141.25 / $263.03	Professional	26	$107.15	$141.25	$263.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $478.63 / $812.83	Professional	TC	$281.84	$478.63	$812.83