Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $48.58 / $240.80 / $522.26	Facility		$48.58	$240.80	$522.26
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.29 / $10.61 / $37.15	Facility	26	$7.29	$10.61	$37.15
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $27.18 / $182.92 / $522.26	Facility	TC	$27.18	$182.92	$522.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $14.24 / $38.92 / $139.00	Professional		$14.24	$38.92	$139.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.33 / $14.27 / $40.04	Professional	26	$7.33	$14.27	$40.04
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $25.52 / $129.76 / $236.04	Professional	50	$25.52	$129.76	$236.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.06 / $32.61 / $101.82	Professional	TC	$25.06	$32.61	$101.82
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $30.70 / $52.12 / $69.18	Professional		$30.70	$52.12	$69.18
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.50 / $11.40 / $15.08	Professional	26	$6.50	$11.40	$15.08
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $78.78 / $102.26 / $111.65	Professional	50	$78.78	$102.26	$111.65
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $50.45 / $52.63 / $61.06	Professional	TC	$50.45	$52.63	$61.06
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $34.94 / $65.34 / $106.28	Facility		$34.94	$65.34	$106.28
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $30.43 / $46.26 / $96.59	Professional		$30.43	$46.26	$96.59
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.75 / $11.39 / $22.33	Professional	26	$7.75	$11.39	$22.33
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $45.65 / $69.39 / $144.88	Professional	50	$45.65	$69.39	$144.88
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $22.65 / $36.89 / $74.87	Professional	TC	$22.65	$36.89	$74.87
CareSource Facility/Professional Facility Modifier Low / Median / High Price $10.27 / $39.69 / $56.13	Facility		$10.27	$39.69	$56.13
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.51 / $35.13 / $61.12	Professional		$8.51	$35.13	$61.12
Cigna Facility/Professional Facility Modifier Low / Median / High Price $47.96 / $72.38 / $136.00	Facility		$47.96	$72.38	$136.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.61 / $9.61 / $9.61	Facility	26	$9.61	$9.61	$9.61
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $36.90 / $36.90 / $36.90	Facility	TC	$36.90	$36.90	$36.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $29.74 / $53.04 / $100.47	Professional		$29.74	$53.04	$100.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.01 / $13.41 / $22.77	Professional	26	$8.01	$13.41	$22.77
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.74 / $41.51 / $78.51	Professional	TC	$22.74	$41.51	$78.51
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $44.10 / $69.20 / $147.41	Professional		$44.10	$69.20	$147.41
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.93 / $14.24 / $30.73	Professional	26	$8.93	$14.24	$30.73
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $35.17 / $56.06 / $117.56	Professional	TC	$35.17	$56.06	$117.56
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $770.01 / $1,663.61 / $1,750.00	Facility		$770.01	$1,663.61	$1,750.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $11.69 / $43.84 / $73.09	Professional		$11.69	$43.84	$73.09
United Facility/Professional Professional Modifier Low / Median / High Price $32.88 / $47.02 / $85.97	Professional		$32.88	$47.02	$85.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.95 / $10.85 / $19.79	Professional	26	$7.95	$10.85	$19.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.11 / $33.90 / $66.34	Professional	TC	$24.11	$33.90	$66.34