Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $44.67 / $190.55 / $524.81	Facility		$44.67	$190.55	$524.81
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.24 / $15.14 / $38.02	Facility	26	$7.24	$15.14	$38.02
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $19.95 / $61.66 / $354.81	Facility	TC	$19.95	$61.66	$354.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $12.30 / $36.31 / $120.23	Professional		$12.30	$36.31	$120.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $14.13 / $40.74	Professional	26	$7.08	$14.13	$40.74
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $42.66 / $131.83 / $239.88	Professional	50	$42.66	$131.83	$239.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $33.11 / $66.07	Professional	TC	$19.05	$33.11	$66.07
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $20.89 / $30.20 / $56.23	Professional		$20.89	$30.20	$56.23
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $8.91 / $14.45	Professional	26	$6.46	$8.91	$14.45
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $36.31 / $64.57 / $95.50	Professional	50	$36.31	$64.57	$95.50
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $16.22 / $22.91 / $42.66	Professional	TC	$16.22	$22.91	$42.66
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $30.20 / $58.88 / $79.43	Facility		$30.20	$58.88	$79.43
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $40.74 / $69.18	Professional		$30.90	$40.74	$69.18
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $11.48 / $19.50	Professional	26	$8.32	$11.48	$19.50
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $45.71 / $60.26 / $104.71	Professional	50	$45.71	$60.26	$104.71
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $28.84 / $51.29	Professional	TC	$22.39	$28.84	$51.29
CareSource Facility/Professional Facility Modifier Low / Median / High Price $11.48 / $33.11 / $51.29	Facility		$11.48	$33.11	$51.29
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.51 / $25.70 / $39.81	Professional		$8.51	$25.70	$39.81
Cigna Facility/Professional Facility Modifier Low / Median / High Price $38.90 / $53.70 / $158.49	Facility		$38.90	$53.70	$158.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $45.71 / $79.43	Professional		$26.30	$45.71	$79.43
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $12.30 / $21.88	Professional	26	$7.59	$12.30	$21.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $33.88 / $58.88	Professional	TC	$20.42	$33.88	$58.88
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $43.65 / $112.20	Professional		$33.88	$43.65	$112.20
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $11.48 / $30.20	Professional	26	$8.51	$11.48	$30.20
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $32.36 / $83.18	Professional	TC	$25.12	$32.36	$83.18
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $1,288.25 / $1,288.25 / $1,737.80	Facility		$1,288.25	$1,288.25	$1,737.80
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $8.71 / $30.20 / $54.95	Professional		$8.71	$30.20	$54.95
United Facility/Professional Facility Modifier Low / Median / High Price $26.30 / $218.78 / $218.78	Facility		$26.30	$218.78	$218.78
United Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $38.02 / $67.61	Professional		$29.51	$38.02	$67.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $10.00 / $18.20	Professional	26	$7.94	$10.00	$18.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $27.54 / $50.12	Professional	TC	$20.89	$27.54	$50.12