Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $99.06 / $137.84 / $381.38	Facility	26	$99.06	$137.84	$381.38
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $45.79 / $94.76 / $176.28	Facility	53	$45.79	$94.76	$176.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $228.93 / $295.87 / $617.44	Professional		$228.93	$295.87	$617.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $99.06 / $118.87 / $323.97	Professional	26	$99.06	$118.87	$323.97
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $130.44 / $187.78 / $237.87	Professional	26	$130.44	$187.78	$237.87
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $208.44 / $394.31 / $760.26	Professional		$208.44	$394.31	$760.26
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $100.05 / $172.86 / $324.08	Professional	26	$100.05	$172.86	$324.08
CareSource Facility/Professional Professional Modifier Low / Median / High Price $104.58 / $154.04 / $291.86	Professional		$104.58	$154.04	$291.86
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $120.36 / $120.36 / $120.36	Facility	26	$120.36	$120.36	$120.36
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $52.64 / $52.64 / $52.64	Facility	53	$52.64	$52.64	$52.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $270.14 / $409.34 / $666.31	Professional		$270.14	$409.34	$666.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $118.33 / $167.48 / $291.27	Professional	26	$118.33	$167.48	$291.27
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $247.97 / $338.15 / $851.42	Professional		$247.97	$338.15	$851.42
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $111.25 / $151.71 / $317.95	Professional	26	$111.25	$151.71	$317.95
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $179.28 / $179.28 / $851.73	Professional	53	$179.28	$179.28	$851.73
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $162.31 / $216.26 / $449.48	Professional		$162.31	$216.26	$449.48
United Facility/Professional Professional Modifier Low / Median / High Price $244.56 / $364.76 / $677.19	Professional		$244.56	$364.76	$677.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $109.64 / $152.07 / $268.37	Professional	26	$109.64	$152.07	$268.37