Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $353.64 / $599.48 / $1,781.53	Facility	26	$353.64	$599.48	$1,781.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,404.22 / $1,945.46 / $5,135.68	Professional		$1,404.22	$1,945.46	$5,135.68
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $328.02 / $499.73 / $1,999.75	Professional	26	$328.02	$499.73	$1,999.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $1,076.20 / $1,521.09 / $3,702.59	Professional	TC	$1,076.20	$1,521.09	$3,702.59
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $1,623.19 / $1,885.98 / $2,723.99	Professional		$1,623.19	$1,885.98	$2,723.99
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $395.92 / $667.76 / $765.12	Professional	26	$395.92	$667.76	$765.12
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,616.55 / $2,241.98 / $4,600.35	Professional		$1,616.55	$2,241.98	$4,600.35
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $370.89 / $510.30 / $1,070.11	Professional	26	$370.89	$510.30	$1,070.11
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $1,210.16 / $1,764.51 / $3,591.60	Professional	TC	$1,210.16	$1,764.51	$3,591.60
CareSource Facility/Professional Professional Modifier Low / Median / High Price $414.13 / $1,337.11 / $3,700.52	Professional		$414.13	$1,337.11	$3,700.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,894.43 / $3,130.46 / $5,210.24	Professional		$1,894.43	$3,130.46	$5,210.24
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $396.20 / $683.91 / $1,179.53	Professional	26	$396.20	$683.91	$1,179.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $1,510.79 / $2,534.75 / $4,124.50	Professional	TC	$1,510.79	$2,534.75	$4,124.50
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,975.79 / $2,782.00 / $3,982.87	Professional		$1,975.79	$2,782.00	$3,982.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $453.32 / $619.83 / $824.22	Professional	26	$453.32	$619.83	$824.22
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $1,522.47 / $2,076.09 / $3,982.87	Professional	TC	$1,522.47	$2,076.09	$3,982.87
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $642.89 / $2,287.94 / $3,322.91	Professional		$642.89	$2,287.94	$3,322.91
United Facility/Professional Professional Modifier Low / Median / High Price $1,728.68 / $2,420.60 / $4,860.59	Professional		$1,728.68	$2,420.60	$4,860.59
United Facility/Professional Professional Modifier 26 Low / Median / High Price $363.93 / $502.88 / $1,100.61	Professional	26	$363.93	$502.88	$1,100.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $1,321.44 / $1,971.44 / $3,804.73	Professional	TC	$1,321.44	$1,971.44	$3,804.73