Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $189.68 / $416.89 / $956.87	Facility	26	$189.68	$416.89	$956.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $356.65 / $502.89 / $1,248.39	Professional		$356.65	$502.89	$1,248.39
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $188.34 / $297.12 / $626.95	Professional	26	$188.34	$297.12	$626.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $180.70 / $265.77 / $684.21	Professional	TC	$180.70	$265.77	$684.21
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $420.77 / $432.72 / $638.66	Professional		$420.77	$432.72	$638.66
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $212.07 / $370.00 / $409.86	Professional	26	$212.07	$370.00	$409.86
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $415.51 / $579.42 / $1,225.15	Professional		$415.51	$579.42	$1,225.15
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $204.53 / $272.70 / $574.77	Professional	26	$204.53	$272.70	$574.77
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $220.39 / $323.55 / $647.57	Professional	TC	$220.39	$323.55	$647.57
CareSource Facility/Professional Professional Modifier Low / Median / High Price $222.10 / $454.51 / $975.74	Professional		$222.10	$454.51	$975.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $490.42 / $813.52 / $1,445.04	Professional		$490.42	$813.52	$1,445.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $239.30 / $390.28 / $690.96	Professional	26	$239.30	$390.28	$690.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $251.11 / $425.31 / $754.08	Professional	TC	$251.11	$425.31	$754.08
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $507.85 / $809.60 / $3,503.00	Professional		$507.85	$809.60	$3,503.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $242.84 / $387.12 / $1,646.41	Professional	26	$242.84	$387.12	$1,646.41
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $265.01 / $422.48 / $1,856.59	Professional	TC	$265.01	$422.48	$1,856.59
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $315.77 / $408.41 / $854.11	Professional		$315.77	$408.41	$854.11
United Facility/Professional Professional Modifier Low / Median / High Price $453.45 / $603.60 / $1,121.42	Professional		$453.45	$603.60	$1,121.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $209.07 / $285.20 / $511.84	Professional	26	$209.07	$285.20	$511.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $242.77 / $330.16 / $594.71	Professional	TC	$242.77	$330.16	$594.71