Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $121.35 / $477.54 / $4,345.89	Facility		$121.35	$477.54	$4,345.89
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $70.87 / $104.98 / $364.00	Facility	26	$70.87	$104.98	$364.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $119.85 / $197.03 / $480.59	Professional		$119.85	$197.03	$480.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.81 / $74.16 / $224.68	Professional	26	$51.81	$74.16	$224.68
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $59.93 / $67.59 / $432.19	Professional	52	$59.93	$67.59	$432.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $55.32 / $98.29 / $411.80	Professional	TC	$55.32	$98.29	$411.80
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $275.56 / $275.56 / $275.56	Professional		$275.56	$275.56	$275.56
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $65.84 / $116.21 / $151.18	Professional	26	$65.84	$116.21	$151.18
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $109.18 / $223.64 / $589.62	Facility		$109.18	$223.64	$589.62
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $145.18 / $253.34 / $720.49	Professional		$145.18	$253.34	$720.49
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $58.52 / $91.75 / $191.56	Professional	26	$58.52	$91.75	$191.56
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $66.30 / $128.65 / $651.27	Professional	TC	$66.30	$128.65	$651.27
CareSource Facility/Professional Facility Modifier Low / Median / High Price $77.40 / $110.01 / $202.98	Facility		$77.40	$110.01	$202.98
CareSource Facility/Professional Professional Modifier Low / Median / High Price $65.23 / $106.98 / $187.81	Professional		$65.23	$106.98	$187.81
Cigna Facility/Professional Facility Modifier Low / Median / High Price $108.21 / $151.34 / $1,202.45	Facility		$108.21	$151.34	$1,202.45
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.06 / $94.06 / $94.06	Facility	26	$94.06	$94.06	$94.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $152.38 / $339.88 / $850.48	Professional		$152.38	$339.88	$850.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.32 / $105.81 / $220.92	Professional	26	$60.32	$105.81	$220.92
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $81.14 / $189.16 / $525.37	Professional	TC	$81.14	$189.16	$525.37
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $158.81 / $288.74 / $1,326.23	Professional		$158.81	$288.74	$1,326.23
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $87.07 / $138.80 / $336.81	Professional	26	$87.07	$138.80	$336.81
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $132.21 / $132.21 / $215.02	Professional	52	$132.21	$132.21	$215.02
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $71.75 / $130.46 / $1,278.41	Professional	TC	$71.75	$130.46	$1,278.41
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $89.09 / $131.69 / $256.20	Professional		$89.09	$131.69	$256.20
United Facility/Professional Professional Modifier Low / Median / High Price $158.74 / $263.31 / $567.58	Professional		$158.74	$263.31	$567.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.49 / $93.59 / $177.88	Professional	26	$58.49	$93.59	$177.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $74.06 / $133.74 / $450.09	Professional	TC	$74.06	$133.74	$450.09