Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $76.65 / $112.25 / $295.10	Facility	26	$76.65	$112.25	$295.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $220.72 / $331.86 / $974.07	Professional		$220.72	$331.86	$974.07
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $76.65 / $96.61 / $271.00	Professional	26	$76.65	$96.61	$271.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $144.07 / $165.09 / $358.56	Professional	TC	$144.07	$165.09	$358.56
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $389.32 / $412.96 / $530.79	Professional		$389.32	$412.96	$530.79
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $138.82 / $141.34 / $141.34	Professional	26	$138.82	$141.34	$141.34
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $222.43 / $394.29 / $728.55	Professional		$222.43	$394.29	$728.55
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $77.84 / $136.82 / $259.61	Professional	26	$77.84	$136.82	$259.61
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $134.83 / $238.33 / $468.70	Professional	TC	$134.83	$238.33	$468.70
CareSource Facility/Professional Professional Modifier Low / Median / High Price $80.97 / $164.54 / $289.74	Professional		$80.97	$164.54	$289.74
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.46 / $93.46 / $93.46	Facility	26	$93.46	$93.46	$93.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $257.56 / $377.24 / $680.22	Professional		$257.56	$377.24	$680.22
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $94.90 / $131.49 / $220.81	Professional	26	$94.90	$131.49	$220.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $157.09 / $227.22 / $405.78	Professional	TC	$157.09	$227.22	$405.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $244.67 / $320.30 / $1,562.02	Professional		$244.67	$320.30	$1,562.02
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $86.27 / $112.94 / $542.44	Professional	26	$86.27	$112.94	$542.44
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $158.40 / $207.36 / $1,019.52	Professional	TC	$158.40	$207.36	$1,019.52
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $125.61 / $250.56 / $433.40	Professional		$125.61	$250.56	$433.40
United Facility/Professional Professional Modifier Low / Median / High Price $231.68 / $330.20 / $639.35	Professional		$231.68	$330.20	$639.35
United Facility/Professional Professional Modifier 26 Low / Median / High Price $86.91 / $122.19 / $235.63	Professional	26	$86.91	$122.19	$235.63
United Facility/Professional Professional Modifier TC Low / Median / High Price $147.37 / $207.67 / $409.38	Professional	TC	$147.37	$207.67	$409.38