Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $120.56 / $464.16 / $1,482.60	Facility		$120.56	$464.16	$1,482.60
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.43 / $25.30 / $82.51	Facility	26	$21.43	$25.30	$82.51
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.49 / $144.66 / $342.33	Professional		$52.49	$144.66	$342.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.48 / $27.33 / $57.15	Professional	26	$20.48	$27.33	$57.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $99.13 / $113.93 / $262.52	Professional	TC	$99.13	$113.93	$262.52
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $105.25 / $219.20 / $237.74	Professional		$105.25	$219.20	$237.74
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $17.62 / $32.01 / $40.53	Professional	26	$17.62	$32.01	$40.53
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $182.51 / $377.38 / $445.63	Facility		$182.51	$377.38	$445.63
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $115.24 / $190.92 / $364.87	Professional		$115.24	$190.92	$364.87
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.64 / $27.94 / $60.71	Professional	26	$19.64	$27.94	$60.71
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $95.60 / $160.22 / $303.57	Professional	TC	$95.60	$160.22	$303.57
CareSource Facility/Professional Facility Modifier Low / Median / High Price $27.85 / $143.49 / $192.37	Facility		$27.85	$143.49	$192.37
CareSource Facility/Professional Professional Modifier Low / Median / High Price $22.51 / $116.97 / $190.53	Professional		$22.51	$116.97	$190.53
Cigna Facility/Professional Facility Modifier Low / Median / High Price $147.30 / $269.67 / $375.31	Facility		$147.30	$269.67	$375.31
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.35 / $26.35 / $42.74	Facility	26	$26.35	$26.35	$42.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $139.37 / $215.09 / $386.74	Professional		$139.37	$215.09	$386.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.97 / $31.23 / $53.01	Professional	26	$20.97	$31.23	$53.01
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $121.58 / $186.61 / $338.65	Professional	TC	$121.58	$186.61	$338.65
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $151.15 / $206.12 / $455.12	Professional		$151.15	$206.12	$455.12
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $24.01 / $31.00 / $70.89	Professional	26	$24.01	$31.00	$70.89
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $127.14 / $173.37 / $408.76	Professional	TC	$127.14	$173.37	$408.76
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $26.25 / $143.49 / $237.24	Professional		$26.25	$143.49	$237.24
United Facility/Professional Professional Modifier Low / Median / High Price $150.93 / $216.30 / $373.39	Professional		$150.93	$216.30	$373.39
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.80 / $30.40 / $52.95	Professional	26	$21.80	$30.40	$52.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $125.37 / $181.58 / $314.07	Professional	TC	$125.37	$181.58	$314.07