Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.07 / $42.08 / $75.65	Facility	26	$42.07	$42.08	$75.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $292.89 / $348.04 / $667.20	Professional		$292.89	$348.04	$667.20
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $146.44 / $170.71 / $230.73	Professional	52	$146.44	$170.71	$230.73
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $252.77 / $303.33 / $569.08	Professional	TC	$252.77	$303.33	$569.08
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $669.27 / $669.27 / $669.27	Professional		$669.27	$669.27	$669.27
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $270.48 / $421.92 / $758.96	Professional		$270.48	$421.92	$758.96
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $233.52 / $369.42 / $657.46	Professional	TC	$233.52	$369.42	$657.46
CareSource Facility/Professional Professional Modifier Low / Median / High Price $50.20 / $366.13 / $546.69	Professional		$50.20	$366.13	$546.69
Cigna Facility/Professional Professional Modifier Low / Median / High Price $118.46 / $416.44 / $816.21	Professional		$118.46	$416.44	$816.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $278.49 / $383.90 / $771.54	Professional	TC	$278.49	$383.90	$771.54
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $396.72 / $468.85 / $6,505.00	Professional		$396.72	$468.85	$6,505.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $47.45 / $56.08 / $975.75	Professional	26	$47.45	$56.08	$975.75
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $238.14 / $238.14 / $431.10	Professional	52	$238.14	$238.14	$431.10
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $349.25 / $412.75 / $5,529.25	Professional	TC	$349.25	$412.75	$5,529.25
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $45.91 / $371.36 / $640.78	Professional		$45.91	$371.36	$640.78
United Facility/Professional Professional Modifier Low / Median / High Price $311.17 / $459.94 / $848.75	Professional		$311.17	$459.94	$848.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $268.72 / $392.66 / $735.23	Professional	TC	$268.72	$392.66	$735.23