Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $142.18 / $550.20 / $1,366.40	Facility		$142.18	$550.20	$1,366.40
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.96 / $44.46 / $68.15	Facility	26	$37.96	$44.46	$68.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $143.69 / $211.81 / $343.32	Professional		$143.69	$211.81	$343.32
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.96 / $54.92 / $106.28	Professional	26	$37.96	$54.92	$106.28
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $91.66 / $146.07 / $211.15	Professional	52	$91.66	$146.07	$211.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $99.34 / $133.94 / $227.46	Professional	TC	$99.34	$133.94	$227.46
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $119.18 / $210.85 / $231.05	Professional		$119.18	$210.85	$231.05
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $37.29 / $67.39 / $69.33	Professional	26	$37.29	$67.39	$69.33
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $57.76 / $242.95 / $242.95	Professional	52	$57.76	$242.95	$242.95
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $86.65 / $101.10 / $161.82	Professional	TC	$86.65	$101.10	$161.82
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $400.00 / $2,354.58 / $2,831.20	Facility		$400.00	$2,354.58	$2,831.20
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $100.11 / $212.64 / $355.59	Professional		$100.11	$212.64	$355.59
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $31.65 / $58.37 / $100.33	Professional	26	$31.65	$58.37	$100.33
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $78.44 / $147.01 / $255.26	Professional	TC	$78.44	$147.01	$255.26
CareSource Facility/Professional Facility Modifier Low / Median / High Price $44.76 / $112.04 / $180.26	Facility		$44.76	$112.04	$180.26
CareSource Facility/Professional Professional Modifier Low / Median / High Price $43.74 / $107.51 / $180.26	Professional		$43.74	$107.51	$180.26
Cigna Facility/Professional Facility Modifier Low / Median / High Price $106.00 / $121.17 / $133.00	Facility		$106.00	$121.17	$133.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $158.60 / $244.25 / $406.98	Professional		$158.60	$244.25	$406.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.75 / $68.75 / $120.09	Professional	26	$42.75	$68.75	$120.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $118.70 / $171.22 / $282.24	Professional	TC	$118.70	$171.22	$282.24
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $136.90 / $161.79 / $704.00	Professional		$136.90	$161.79	$704.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $28.16 / $48.49 / $127.39	Professional	26	$28.16	$48.49	$127.39
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $82.18 / $82.18 / $148.76	Professional	52	$82.18	$82.18	$148.76
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $95.88 / $113.31 / $675.84	Professional	TC	$95.88	$113.31	$675.84
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $358.61 / $358.61 / $358.61	Facility		$358.61	$358.61	$358.61
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $56.91 / $151.71 / $240.87	Professional		$56.91	$151.71	$240.87
United Facility/Professional Professional Modifier Low / Median / High Price $150.47 / $247.57 / $405.12	Professional		$150.47	$247.57	$405.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.47 / $68.09 / $107.63	Professional	26	$40.47	$68.09	$107.63
United Facility/Professional Professional Modifier TC Low / Median / High Price $112.26 / $179.07 / $289.56	Professional	TC	$112.26	$179.07	$289.56