Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $110.17 / $129.06 / $261.36	Facility	26	$110.17	$129.06	$261.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $554.14 / $680.08 / $1,221.92	Professional		$554.14	$680.08	$1,221.92
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $110.17 / $130.04 / $431.54	Professional	26	$110.17	$130.04	$431.54
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $272.83 / $303.97 / $525.09	Professional	52	$272.83	$303.97	$525.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $442.08 / $529.33 / $960.19	Professional	TC	$442.08	$529.33	$960.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $579.34 / $822.89 / $1,128.57	Professional		$579.34	$822.89	$1,128.57
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $116.01 / $169.26 / $208.85	Professional	26	$116.01	$169.26	$208.85
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $492.29 / $492.29 / $492.29	Professional	TC	$492.29	$492.29	$492.29
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $459.30 / $721.83 / $1,710.32	Professional		$459.30	$721.83	$1,710.32
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $85.43 / $144.52 / $328.29	Professional	26	$85.43	$144.52	$328.29
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $373.86 / $568.27 / $1,231.28	Professional	TC	$373.86	$568.27	$1,231.28
CareSource Facility/Professional Professional Modifier Low / Median / High Price $131.72 / $592.08 / $926.28	Professional		$131.72	$592.08	$926.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $618.28 / $917.50 / $1,674.71	Professional		$618.28	$917.50	$1,674.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $127.89 / $193.38 / $347.41	Professional	26	$127.89	$193.38	$347.41
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $486.99 / $705.08 / $1,319.42	Professional	TC	$486.99	$705.08	$1,319.42
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $668.66 / $790.23 / $4,037.69	Professional		$668.66	$790.23	$4,037.69
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $123.74 / $146.24 / $779.63	Professional	26	$123.74	$146.24	$779.63
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $401.39 / $401.39 / $726.62	Professional	52	$401.39	$401.39	$726.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $544.91 / $643.99 / $3,258.00	Professional	TC	$544.91	$643.99	$3,258.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $169.94 / $792.61 / $1,083.33	Professional		$169.94	$792.61	$1,083.33
United Facility/Professional Professional Modifier Low / Median / High Price $559.57 / $954.57 / $1,616.90	Professional		$559.57	$954.57	$1,616.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $108.33 / $183.42 / $300.75	Professional	26	$108.33	$183.42	$300.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $446.04 / $710.72 / $1,316.15	Professional	TC	$446.04	$710.72	$1,316.15