Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $30.71 / $110.62 / $491.40	Facility		$30.71	$110.62	$491.40
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.00 / $10.47 / $35.68	Facility	26	$7.00	$10.47	$35.68
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $21.91 / $41.53 / $201.32	Facility	TC	$21.91	$41.53	$201.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $18.72 / $34.78 / $120.02	Professional		$18.72	$34.78	$120.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.90 / $12.48 / $37.44	Professional	26	$6.90	$12.48	$37.44
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $30.76 / $114.72 / $310.08	Professional	50	$30.76	$114.72	$310.08
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $12.41 / $14.74 / $41.07	Professional	52	$12.41	$14.74	$41.07
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.07 / $24.59 / $58.18	Professional	TC	$20.07	$24.59	$58.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $25.09 / $43.59 / $60.66	Professional		$25.09	$43.59	$60.66
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.54 / $10.18 / $14.90	Professional	26	$6.54	$10.18	$14.90
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $59.96 / $64.40 / $182.50	Professional	50	$59.96	$64.40	$182.50
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $39.25 / $39.25 / $39.25	Professional	TC	$39.25	$39.25	$39.25
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $28.92 / $53.66 / $84.60	Facility		$28.92	$53.66	$84.60
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $26.19 / $38.78 / $79.48	Professional		$26.19	$38.78	$79.48
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.49 / $11.05 / $21.41	Professional	26	$7.49	$11.05	$21.41
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $38.83 / $58.48 / $120.16	Professional	50	$38.83	$58.48	$120.16
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $18.64 / $29.08 / $60.59	Professional	TC	$18.64	$29.08	$60.59
CareSource Facility/Professional Facility Modifier Low / Median / High Price $9.84 / $30.90 / $45.74	Facility		$9.84	$30.90	$45.74
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.16 / $27.31 / $49.90	Professional		$8.16	$27.31	$49.90
Cigna Facility/Professional Facility Modifier Low / Median / High Price $38.02 / $57.05 / $136.00	Facility		$38.02	$57.05	$136.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.19 / $9.19 / $9.19	Facility	26	$9.19	$9.19	$9.19
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 $26.77 / $46.45 / $84.43	Professional		$26.77	$46.45	$84.43
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.61 / $13.35 / $21.67	Professional	26	$7.61	$13.35	$21.67
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.62 / $33.92 / $62.52	Professional	TC	$19.62	$33.92	$62.52
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $35.94 / $57.29 / $120.12	Professional		$35.94	$57.29	$120.12
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.58 / $13.68 / $29.53	Professional	26	$8.58	$13.68	$29.53
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $29.91 / $29.91 / $42.04	Professional	52	$29.91	$29.91	$42.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $27.36 / $43.61 / $91.45	Professional	TC	$27.36	$43.61	$91.45
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $1,261.90 / $2,150.00 / $3,328.15	Facility		$1,261.90	$2,150.00	$3,328.15
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $11.23 / $35.32 / $58.81	Professional		$11.23	$35.32	$58.81
United Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $39.78 / $70.65	Professional		$28.18	$39.78	$70.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.58 / $10.34 / $19.00	Professional	26	$7.58	$10.34	$19.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.46 / $27.75 / $53.71	Professional	TC	$20.46	$27.75	$53.71