Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $96.43 / $284.36 / $1,185.66	Facility		$96.43	$284.36	$1,185.66
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.35 / $45.54 / $154.54	Facility	26	$30.35	$45.54	$154.54
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $66.08 / $206.72 / $420.62	Facility	TC	$66.08	$206.72	$420.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.32 / $143.07 / $293.91	Professional		$89.32	$143.07	$293.91
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.00 / $41.53 / $99.94	Professional	26	$30.00	$41.53	$99.94
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $41.72 / $48.22 / $119.59	Professional	52	$41.72	$48.22	$119.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $59.65 / $92.53 / $198.04	Professional	TC	$59.65	$92.53	$198.04
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $88.82 / $148.07 / $194.00	Professional		$88.82	$148.07	$194.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.99 / $49.23 / $64.52	Professional	26	$25.99	$49.23	$64.52
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $84.66 / $116.43 / $125.16	Professional	TC	$84.66	$116.43	$125.16
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $103.49 / $204.75 / $276.00	Facility		$103.49	$204.75	$276.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $97.58 / $144.69 / $272.24	Professional		$97.58	$144.69	$272.24
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $30.71 / $46.47 / $82.43	Professional	26	$30.71	$46.47	$82.43
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $64.51 / $97.79 / $188.52	Professional	TC	$64.51	$97.79	$188.52
CareSource Facility/Professional Facility Modifier Low / Median / High Price $42.83 / $90.12 / $146.03	Facility		$42.83	$90.12	$146.03
CareSource Facility/Professional Professional Modifier Low / Median / High Price $34.76 / $76.29 / $142.28	Professional		$34.76	$76.29	$142.28
Cigna Facility/Professional Facility Modifier Low / Median / High Price $106.07 / $161.46 / $248.00	Facility		$106.07	$161.46	$248.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.13 / $40.13 / $40.13	Facility	26	$40.13	$40.13	$40.13
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $82.40 / $82.40 / $82.40	Facility	TC	$82.40	$82.40	$82.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $106.73 / $167.64 / $284.76	Professional		$106.73	$167.64	$284.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.01 / $52.70 / $93.51	Professional	26	$34.01	$52.70	$93.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.05 / $113.75 / $192.50	Professional	TC	$72.05	$113.75	$192.50
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $104.49 / $133.74 / $340.57	Professional		$104.49	$133.74	$340.57
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $33.78 / $43.91 / $107.30	Professional	26	$33.78	$43.91	$107.30
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $95.69 / $95.69 / $134.47	Professional	52	$95.69	$95.69	$134.47
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $70.70 / $87.79 / $306.52	Professional	TC	$70.70	$87.79	$306.52
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $43.78 / $101.82 / $179.43	Professional		$43.78	$101.82	$179.43
United Facility/Professional Facility Modifier Low / Median / High Price $250.18 / $261.88 / $261.88	Facility		$250.18	$261.88	$261.88
United Facility/Professional Professional Modifier Low / Median / High Price $105.46 / $150.60 / $245.68	Professional		$105.46	$150.60	$245.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.65 / $46.83 / $79.94	Professional	26	$35.65	$46.83	$79.94
United Facility/Professional Professional Modifier TC Low / Median / High Price $71.09 / $102.03 / $169.86	Professional	TC	$71.09	$102.03	$169.86