Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.57 / $141.25 / $346.74	Facility	26	$64.57	$141.25	$346.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $660.69 / $1,230.27	Professional		$354.81	$660.69	$1,230.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $89.13 / $208.93	Professional	26	$64.57	$89.13	$208.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $416.87 / $870.96	Professional	TC	$281.84	$416.87	$870.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $478.63 / $758.58	Professional		$302.00	$478.63	$758.58
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $91.20 / $134.90	Professional	26	$60.26	$91.20	$134.90
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $309.03 / $309.03 / $309.03	Professional	TC	$309.03	$309.03	$309.03
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $562.34 / $870.96	Professional		$389.05	$562.34	$870.96
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $104.71 / $154.88	Professional	26	$77.62	$104.71	$154.88
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $338.84 / $489.78 / $724.44	Professional	TC	$338.84	$489.78	$724.44
CareSource Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $691.83 / $870.96	Professional		$169.82	$691.83	$870.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $776.25 / $1,202.26	Professional		$446.68	$776.25	$1,202.26
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $128.82 / $204.17	Professional	26	$79.43	$128.82	$204.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $354.81 / $630.96 / $1,023.29	Professional	TC	$354.81	$630.96	$1,023.29
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $501.19 / $1,071.52	Professional		$380.19	$501.19	$1,071.52
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $131.83 / $380.19	Professional	26	$83.18	$131.83	$380.19
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $380.19 / $416.87 / $870.96	Professional	TC	$380.19	$416.87	$870.96
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $489.78 / $616.60	Professional		$104.71	$489.78	$616.60
United Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $676.08 / $1,122.02	Professional		$436.52	$676.08	$1,122.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $114.82 / $194.98	Professional	26	$79.43	$114.82	$194.98
United Facility/Professional Professional Modifier TC Low / Median / High Price $371.54 / $549.54 / $933.25	Professional	TC	$371.54	$549.54	$933.25