Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $46.98 / $163.80 / $588.22	Facility		$46.98	$163.80	$588.22
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.87 / $11.27 / $40.13	Facility	26	$7.87	$11.27	$40.13
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $22.14 / $180.76 / $538.73	Facility	TC	$22.14	$180.76	$538.73
Aetna Facility/Professional Professional Modifier Low / Median / High Price $9.15 / $34.68 / $97.07	Professional		$9.15	$34.68	$97.07
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.67 / $12.16 / $43.24	Professional	26	$7.67	$12.16	$43.24
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $29.92 / $77.00 / $199.60	Professional	50	$29.92	$77.00	$199.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.14 / $25.93 / $86.60	Professional	TC	$19.14	$25.93	$86.60
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $25.96 / $43.79 / $58.33	Professional		$25.96	$43.79	$58.33
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.20 / $12.71 / $16.75	Professional	26	$7.20	$12.71	$16.75
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $46.75 / $85.05 / $93.68	Professional	50	$46.75	$85.05	$93.68
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $40.38 / $40.98 / $43.77	Professional	TC	$40.38	$40.98	$43.77
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $30.80 / $55.02 / $83.51	Facility		$30.80	$55.02	$83.51
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $28.58 / $41.25 / $81.83	Professional		$28.58	$41.25	$81.83
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $8.33 / $12.30 / $24.11	Professional	26	$8.33	$12.30	$24.11
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $42.72 / $61.90 / $124.38	Professional	50	$42.72	$61.90	$124.38
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $19.20 / $29.08 / $60.71	Professional	TC	$19.20	$29.08	$60.71
CareSource Facility/Professional Facility Modifier Low / Median / High Price $11.06 / $30.90 / $47.10	Facility		$11.06	$30.90	$47.10
CareSource Facility/Professional Professional Modifier Low / Median / High Price $9.21 / $27.31 / $50.14	Professional		$9.21	$27.31	$50.14
Cigna Facility/Professional Facility Modifier Low / Median / High Price $39.14 / $57.05 / $136.00	Facility		$39.14	$57.05	$136.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.36 / $10.36 / $10.36	Facility	26	$10.36	$10.36	$10.36
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $29.08 / $29.08 / $29.08	Facility	TC	$29.08	$29.08	$29.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $27.19 / $46.86 / $84.43	Professional		$27.19	$46.86	$84.43
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.63 / $14.79 / $24.36	Professional	26	$8.63	$14.79	$24.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.67 / $34.14 / $60.94	Professional	TC	$19.67	$34.14	$60.94
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $37.00 / $58.99 / $123.69	Professional		$37.00	$58.99	$123.69
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $9.65 / $15.38 / $33.20	Professional	26	$9.65	$15.38	$33.20
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $27.36 / $43.61 / $91.44	Professional	TC	$27.36	$43.61	$91.44
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $770.01 / $1,663.61 / $2,164.00	Facility		$770.01	$1,663.61	$2,164.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $12.51 / $35.90 / $60.55	Professional		$12.51	$35.90	$60.55
United Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $41.24 / $72.14	Professional		$29.51	$41.24	$72.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.30 / $11.64 / $21.36	Professional	26	$8.30	$11.64	$21.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.26 / $27.47 / $52.14	Professional	TC	$20.26	$27.47	$52.14