Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $122.46 / $420.04 / $1,471.40	Facility		$122.46	$420.04	$1,471.40
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.84 / $27.65 / $76.38	Facility	26	$19.84	$27.65	$76.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $122.46 / $185.99 / $323.44	Professional		$122.46	$185.99	$323.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.84 / $23.60 / $57.73	Professional	26	$19.84	$23.60	$57.73
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $59.50 / $65.09 / $129.55	Professional	52	$59.50	$65.09	$129.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $101.50 / $123.13 / $263.98	Professional	TC	$101.50	$123.13	$263.98
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $96.42 / $198.51 / $216.67	Professional		$96.42	$198.51	$216.67
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $17.42 / $32.84 / $38.19	Professional	26	$17.42	$32.84	$38.19
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $184.52 / $334.51 / $406.72	Facility		$184.52	$334.51	$406.72
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $113.24 / $176.94 / $348.30	Professional		$113.24	$176.94	$348.30
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $18.53 / $28.56 / $55.43	Professional	26	$18.53	$28.56	$55.43
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $94.73 / $148.47 / $292.88	Professional	TC	$94.73	$148.47	$292.88
CareSource Facility/Professional Facility Modifier Low / Median / High Price $26.08 / $130.69 / $176.16	Facility		$26.08	$130.69	$176.16
CareSource Facility/Professional Professional Modifier Low / Median / High Price $21.10 / $106.48 / $174.03	Professional		$21.10	$106.48	$174.03
Cigna Facility/Professional Facility Modifier Low / Median / High Price $145.77 / $244.51 / $337.26	Facility		$145.77	$244.51	$337.26
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.72 / $24.72 / $39.04	Facility	26	$24.72	$24.72	$39.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $127.65 / $201.30 / $368.69	Professional		$127.65	$201.30	$368.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.75 / $31.05 / $56.80	Professional	26	$21.75	$31.05	$56.80
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $107.29 / $170.60 / $308.41	Professional	TC	$107.29	$170.60	$308.41
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $138.41 / $188.75 / $430.01	Professional		$138.41	$188.75	$430.01
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $22.63 / $30.86 / $97.58	Professional	26	$22.63	$30.86	$97.58
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $85.52 / $85.52 / $127.97	Professional	52	$85.52	$85.52	$127.97
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $115.79 / $157.88 / $376.95	Professional	TC	$115.79	$157.88	$376.95
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $22.32 / $122.50 / $206.82	Professional		$22.32	$122.50	$206.82
United Facility/Professional Professional Modifier Low / Median / High Price $134.72 / $196.31 / $338.15	Professional		$134.72	$196.31	$338.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.72 / $31.15 / $52.00	Professional	26	$22.72	$31.15	$52.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.73 / $163.98 / $282.18	Professional	TC	$109.73	$163.98	$282.18