Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $116.51 / $135.75 / $314.26	Facility	26	$116.51	$135.75	$314.26
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $160.83 / $160.83 / $292.52	Facility	53	$160.83	$160.83	$292.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $754.15 / $1,010.53 / $2,211.87	Professional		$754.15	$1,010.53	$2,211.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $115.40 / $182.78 / $437.36	Professional	26	$115.40	$182.78	$437.36
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $345.17 / $409.89 / $736.00	Professional	52	$345.17	$409.89	$736.00
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $142.84 / $163.95 / $292.52	Professional	53	$142.84	$163.95	$292.52
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $626.80 / $767.25 / $1,328.81	Professional	TC	$626.80	$767.25	$1,328.81
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $540.57 / $1,109.03 / $1,251.74	Professional		$540.57	$1,109.03	$1,251.74
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $134.16 / $167.79 / $204.16	Professional	26	$134.16	$167.79	$204.16
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $312.93 / $312.93 / $312.93	Professional	52	$312.93	$312.93	$312.93
Ambetter Facility/Professional Professional Modifier 53 Low / Median / High Price $1,287.74 / $1,287.74 / $1,287.74	Professional	53	$1,287.74	$1,287.74	$1,287.74
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $701.19 / $1,043.44 / $1,772.34	Professional		$701.19	$1,043.44	$1,772.34
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $108.82 / $192.69 / $334.59	Professional	26	$108.82	$192.69	$334.59
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $614.91 / $845.08 / $1,471.14	Professional	TC	$614.91	$845.08	$1,471.14
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $126.71 / $126.71 / $126.71	Facility	26	$126.71	$126.71	$126.71
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $163.30 / $163.30 / $163.30	Facility	53	$163.30	$163.30	$163.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $790.77 / $1,153.10 / $2,074.50	Professional		$790.77	$1,153.10	$2,074.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $125.07 / $216.54 / $365.78	Professional	26	$125.07	$216.54	$365.78
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $1,303.05 / $1,303.05 / $1,441.67	Professional	53	$1,303.05	$1,303.05	$1,441.67
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $654.61 / $934.49 / $1,735.97	Professional	TC	$654.61	$934.49	$1,735.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $741.63 / $1,114.15 / $3,233.91	Professional		$741.63	$1,114.15	$3,233.91
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $117.58 / $176.65 / $538.27	Professional	26	$117.58	$176.65	$538.27
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $389.95 / $389.95 / $649.92	Professional	52	$389.95	$389.95	$649.92
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $389.95 / $649.92 / $844.90	Professional	53	$389.95	$649.92	$844.90
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $624.04 / $937.51 / $2,695.64	Professional	TC	$624.04	$937.51	$2,695.64
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $1,363.10 / $1,811.90 / $2,196.90	Professional		$1,363.10	$1,811.90	$2,196.90
United Facility/Professional Professional Modifier Low / Median / High Price $846.31 / $1,188.32 / $1,889.10	Professional		$846.31	$1,188.32	$1,889.10
United Facility/Professional Professional Modifier 26 Low / Median / High Price $129.15 / $211.86 / $331.14	Professional	26	$129.15	$211.86	$331.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $674.27 / $969.70 / $1,618.79	Professional	TC	$674.27	$969.70	$1,618.79