Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $72.44 / $134.90 / $288.40	Facility	26	$72.44	$134.90	$288.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $275.42 / $707.95	Professional		$173.78	$275.42	$707.95
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $67.61 / $147.91	Professional	26	$51.29	$67.61	$147.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $213.80 / $512.86	Professional	TC	$128.82	$213.80	$512.86
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $173.78 / $389.05	Professional		$173.78	$173.78	$389.05
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $354.81 / $977.24	Professional		$234.42	$354.81	$977.24
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $77.62 / $125.89	Professional	26	$47.86	$77.62	$125.89
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $269.15 / $870.96	Professional	TC	$165.96	$269.15	$870.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $512.86 / $1,148.15	Professional		$199.53	$512.86	$1,148.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $97.72 / $162.18	Professional	26	$52.48	$97.72	$162.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $371.54 / $1,047.13	Professional	TC	$144.54	$371.54	$1,047.13
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $295.12 / $1,380.38	Professional		$245.47	$295.12	$1,380.38
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $79.43 / $269.15	Professional	26	$67.61	$79.43	$269.15
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $194.98 / $194.98 / $194.98	Professional	52	$194.98	$194.98	$194.98
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $213.80 / $1,380.38	Professional	TC	$181.97	$213.80	$1,380.38
United Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $389.05 / $851.14	Professional		$218.78	$389.05	$851.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $72.44 / $144.54	Professional	26	$52.48	$72.44	$144.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $281.84 / $724.44	Professional	TC	$154.88	$281.84	$724.44