Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $114.82 / $134.90 / $363.08	Facility	26	$114.82	$134.90	$363.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $776.25 / $1,548.82	Professional		$575.44	$776.25	$1,548.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $186.21 / $407.38	Professional	26	$114.82	$186.21	$407.38
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $257.04 / $1,258.93 / $1,258.93	Professional	52	$257.04	$1,258.93	$1,258.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $457.09 / $575.44 / $1,096.48	Professional	TC	$457.09	$575.44	$1,096.48
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $562.34 / $630.96 / $1,174.90	Professional		$562.34	$630.96	$1,174.90
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $147.91 / $223.87	Professional	26	$112.20	$147.91	$223.87
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $457.09 / $457.09 / $575.44	Professional	TC	$457.09	$457.09	$575.44
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $794.33 / $1,584.89	Professional		$524.81	$794.33	$1,584.89
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $169.82 / $346.74	Professional	26	$123.03	$169.82	$346.74
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $457.09 / $588.84 / $1,047.13	Professional	TC	$457.09	$588.84	$1,047.13
CareSource Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $616.60 / $912.01	Professional		$144.54	$616.60	$912.01
Cigna Facility/Professional Professional Modifier Low / Median / High Price $645.65 / $1,000.00 / $1,778.28	Professional		$645.65	$1,000.00	$1,778.28
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $208.93 / $354.81	Professional	26	$131.83	$208.93	$354.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $512.86 / $812.83 / $1,445.44	Professional	TC	$512.86	$812.83	$1,445.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $758.58 / $933.25 / $2,884.03	Professional		$758.58	$933.25	$2,884.03
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $162.18 / $812.83	Professional	26	$131.83	$162.18	$812.83
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $416.87 / $416.87 / $758.58	Professional	52	$416.87	$416.87	$758.58
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $630.96 / $776.25 / $2,884.03	Professional	TC	$630.96	$776.25	$2,884.03
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $831.76 / $1,096.48	Professional		$173.78	$831.76	$1,096.48
United Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $954.99 / $1,698.24	Professional		$588.84	$954.99	$1,698.24
United Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $194.98 / $316.23	Professional	26	$120.23	$194.98	$316.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $467.74 / $758.58 / $1,412.54	Professional	TC	$467.74	$758.58	$1,412.54