Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $114.29 / $133.91 / $280.73	Facility	26	$114.29	$133.91	$280.73
Aetna Facility/Professional Professional Modifier Low / Median / High Price $580.34 / $714.69 / $1,321.17	Professional		$580.34	$714.69	$1,321.17
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $114.29 / $136.03 / $328.59	Professional	26	$114.29	$136.03	$328.59
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $284.83 / $317.42 / $552.88	Professional	52	$284.83	$317.42	$552.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $465.22 / $571.87 / $1,028.15	Professional	TC	$465.22	$571.87	$1,028.15
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $636.66 / $1,066.71 / $1,182.04	Professional		$636.66	$1,066.71	$1,182.04
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $121.01 / $199.54 / $218.00	Professional	26	$121.01	$199.54	$218.00
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $266.68 / $266.68 / $266.68	Professional	52	$266.68	$266.68	$266.68
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $516.04 / $516.04 / $516.04	Professional	TC	$516.04	$516.04	$516.04
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $480.18 / $758.57 / $1,694.40	Professional		$480.18	$758.57	$1,694.40
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $88.90 / $149.91 / $344.03	Professional	26	$88.90	$149.91	$344.03
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $391.29 / $594.76 / $1,288.64	Professional	TC	$391.29	$594.76	$1,288.64
CareSource Facility/Professional Professional Modifier Low / Median / High Price $137.46 / $619.92 / $970.07	Professional		$137.46	$619.92	$970.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $650.00 / $989.68 / $1,750.86	Professional		$650.00	$989.68	$1,750.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $133.01 / $207.44 / $356.22	Professional	26	$133.01	$207.44	$356.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $511.90 / $763.75 / $1,389.46	Professional	TC	$511.90	$763.75	$1,389.46
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $700.34 / $827.67 / $2,886.00	Professional		$700.34	$827.67	$2,886.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $129.16 / $152.65 / $808.86	Professional	26	$129.16	$152.65	$808.86
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $420.41 / $420.41 / $761.04	Professional	52	$420.41	$420.41	$761.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $571.17 / $675.03 / $2,886.00	Professional	TC	$571.17	$675.03	$2,886.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $176.33 / $831.94 / $1,133.49	Professional		$176.33	$831.94	$1,133.49
United Facility/Professional Professional Modifier Low / Median / High Price $584.42 / $988.37 / $1,690.42	Professional		$584.42	$988.37	$1,690.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $120.17 / $200.28 / $328.46	Professional	26	$120.17	$200.28	$328.46
United Facility/Professional Professional Modifier TC Low / Median / High Price $466.78 / $793.17 / $1,377.47	Professional	TC	$466.78	$793.17	$1,377.47