Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.00 / $168.77 / $497.78	Facility	26	$55.00	$168.77	$497.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $275.00 / $349.79 / $1,150.53	Professional		$275.00	$349.79	$1,150.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.00 / $120.57 / $320.00	Professional	26	$55.00	$120.57	$320.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $192.00 / $230.00 / $880.56	Professional	TC	$192.00	$230.00	$880.56
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $193.20 / $310.35 / $360.92	Professional		$193.20	$310.35	$360.92
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $89.67 / $141.05 / $201.44	Professional	26	$89.67	$141.05	$201.44
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 $278.27 / $462.02 / $1,215.00	Professional		$278.27	$462.02	$1,215.00
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $90.30 / $145.80 / $299.02	Professional	26	$90.30	$145.80	$299.02
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $188.76 / $359.78 / $905.05	Professional	TC	$188.76	$359.78	$905.05
CareSource Facility/Professional Professional Modifier Low / Median / High Price $114.21 / $325.23 / $594.22	Professional		$114.21	$325.23	$594.22
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $128.28 / $128.28 / $128.28	Facility	26	$128.28	$128.28	$128.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $397.31 / $765.87 / $1,391.91	Professional		$397.31	$765.87	$1,391.91
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.38 / $183.72 / $314.56	Professional	26	$104.38	$183.72	$314.56
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $283.85 / $598.91 / $1,082.19	Professional	TC	$283.85	$598.91	$1,082.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $444.83 / $709.14 / $1,911.48	Professional		$444.83	$709.14	$1,911.48
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $119.35 / $190.27 / $418.08	Professional	26	$119.35	$190.27	$418.08
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $325.49 / $518.89 / $1,911.48	Professional	TC	$325.49	$518.89	$1,911.48
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $116.72 / $363.95 / $677.23	Professional		$116.72	$363.95	$677.23
United Facility/Professional Professional Modifier Low / Median / High Price $405.68 / $661.54 / $1,105.58	Professional		$405.68	$661.54	$1,105.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $108.81 / $156.75 / $265.02	Professional	26	$108.81	$156.75	$265.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $282.83 / $483.92 / $936.07	Professional	TC	$282.83	$483.92	$936.07