Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $43.38 / $111.28 / $678.60	Facility		$43.38	$111.28	$678.60
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.34 / $13.43 / $47.54	Facility	26	$9.34	$13.43	$47.54
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $24.54 / $247.46 / $551.08	Facility	TC	$24.54	$247.46	$551.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $31.89 / $45.00 / $115.15	Professional		$31.89	$45.00	$115.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.35 / $14.51 / $41.00	Professional	26	$9.35	$14.51	$41.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.62 / $30.16 / $70.19	Professional	TC	$22.62	$30.16	$70.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $29.73 / $45.47 / $66.81	Professional		$29.73	$45.47	$66.81
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.36 / $13.57 / $19.27	Professional	26	$8.36	$13.57	$19.27
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $32.40 / $48.33 / $52.17	Professional	TC	$32.40	$48.33	$52.17
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $36.14 / $66.28 / $95.44	Facility		$36.14	$66.28	$95.44
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $34.56 / $48.86 / $94.42	Professional		$34.56	$48.86	$94.42
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.98 / $14.60 / $28.57	Professional	26	$9.98	$14.60	$28.57
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $23.89 / $33.20 / $68.48	Professional	TC	$23.89	$33.20	$68.48
CareSource Facility/Professional Facility Modifier Low / Median / High Price $13.13 / $34.90 / $53.87	Facility		$13.13	$34.90	$53.87
CareSource Facility/Professional Professional Modifier Low / Median / High Price $10.96 / $30.86 / $56.59	Professional		$10.96	$30.86	$56.59
Cigna Facility/Professional Facility Modifier Low / Median / High Price $44.74 / $64.34 / $171.35	Facility		$44.74	$64.34	$171.35
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.30 / $12.30 / $12.30	Facility	26	$12.30	$12.30	$12.30
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $32.79 / $32.79 / $32.79	Facility	TC	$32.79	$32.79	$32.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.79 / $55.66 / $98.61	Professional		$32.79	$55.66	$98.61
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $17.37 / $28.85	Professional	26	$10.23	$17.37	$28.85
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $24.60 / $41.59 / $71.05	Professional	TC	$24.60	$41.59	$71.05
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $42.33 / $67.48 / $141.50	Professional		$42.33	$67.48	$141.50
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $11.42 / $18.20 / $39.38	Professional	26	$11.42	$18.20	$39.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $30.91 / $49.28 / $103.30	Professional	TC	$30.91	$49.28	$103.30
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $175.21 / $210.47 / $942.76	Facility		$175.21	$210.47	$942.76
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $14.07 / $39.34 / $67.72	Professional		$14.07	$39.34	$67.72
United Facility/Professional Professional Modifier Low / Median / High Price $34.76 / $48.01 / $83.20	Professional		$34.76	$48.01	$83.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.93 / $13.86 / $23.10	Professional	26	$9.93	$13.86	$23.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.62 / $33.96 / $59.25	Professional	TC	$24.62	$33.96	$59.25