Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $173.12 / $173.12 / $311.88	Facility	26	$173.12	$173.12	$311.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $268.38 / $316.08 / $610.40	Professional		$268.38	$316.08	$610.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $168.93 / $190.21 / $366.07	Professional	26	$168.93	$190.21	$366.07
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $94.51 / $115.98 / $217.66	Professional	TC	$94.51	$115.98	$217.66
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $262.73 / $386.37 / $509.29	Professional		$262.73	$386.37	$509.29
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $214.90 / $265.31 / $325.54	Professional	26	$214.90	$265.31	$325.54
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $209.87 / $341.55 / $620.87	Professional		$209.87	$341.55	$620.87
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $134.15 / $213.59 / $378.23	Professional	26	$134.15	$213.59	$378.23
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $76.80 / $126.84 / $243.46	Professional	TC	$76.80	$126.84	$243.46
CareSource Facility/Professional Professional Modifier Low / Median / High Price $107.74 / $232.63 / $408.78	Professional		$107.74	$232.63	$408.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $117.60 / $387.76 / $671.27	Professional		$117.60	$387.76	$671.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $194.64 / $255.12 / $431.83	Professional	26	$194.64	$255.12	$431.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $104.78 / $151.30 / $261.79	Professional	TC	$104.78	$151.30	$261.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $302.70 / $357.75 / $1,989.44	Professional		$302.70	$357.75	$1,989.44
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $195.48 / $231.02 / $1,225.15	Professional	26	$195.48	$231.02	$1,225.15
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $107.23 / $126.72 / $764.30	Professional	TC	$107.23	$126.72	$764.30
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $112.10 / $263.45 / $478.84	Professional		$112.10	$263.45	$478.84
United Facility/Professional Professional Modifier Low / Median / High Price $284.27 / $434.00 / $738.83	Professional		$284.27	$434.00	$738.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $169.23 / $271.91 / $443.71	Professional	26	$169.23	$271.91	$443.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $99.97 / $157.18 / $266.57	Professional	TC	$99.97	$157.18	$266.57