Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $269.17 / $269.17 / $525.08	Facility	26	$269.17	$269.17	$525.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,029.28 / $1,124.89 / $2,403.42	Professional		$1,029.28	$1,124.89	$2,403.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $269.17 / $340.95 / $909.84	Professional	26	$269.17	$340.95	$909.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $739.76 / $808.50 / $1,685.63	Professional	TC	$739.76	$808.50	$1,685.63
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $356.72 / $411.60 / $665.35	Professional	26	$356.72	$411.60	$665.35
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,090.30 / $1,680.94 / $3,299.52	Professional		$1,090.30	$1,680.94	$3,299.52
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $308.41 / $493.51 / $881.41	Professional	26	$308.41	$493.51	$881.41
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $715.00 / $1,176.52 / $2,366.21	Professional	TC	$715.00	$1,176.52	$2,366.21
CareSource Facility/Professional Professional Modifier Low / Median / High Price $360.30 / $812.01 / $1,371.66	Professional		$360.30	$812.01	$1,371.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,199.80 / $1,760.11 / $3,066.31	Professional		$1,199.80	$1,760.11	$3,066.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $366.21 / $503.70 / $904.82	Professional	26	$366.21	$503.70	$904.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $833.59 / $1,264.28 / $2,158.79	Professional	TC	$833.59	$1,264.28	$2,158.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,144.03 / $1,351.32 / $5,649.00	Professional		$1,144.03	$1,351.32	$5,649.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $337.98 / $394.31 / $1,694.70	Professional	26	$337.98	$394.31	$1,694.70
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $787.31 / $957.01 / $3,954.30	Professional	TC	$787.31	$957.01	$3,954.30
United Facility/Professional Professional Modifier Low / Median / High Price $1,095.61 / $1,537.32 / $2,957.81	Professional		$1,095.61	$1,537.32	$2,957.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $308.64 / $478.39 / $875.42	Professional	26	$308.64	$478.39	$875.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $786.98 / $1,101.77 / $2,124.58	Professional	TC	$786.98	$1,101.77	$2,124.58