Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $37.11 / $152.56 / $445.16	Facility		$37.11	$152.56	$445.16
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.00 / $11.01 / $35.68	Facility	26	$7.00	$11.01	$35.68
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $19.57 / $69.70 / $308.23	Facility	TC	$19.57	$69.70	$308.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $17.87 / $32.36 / $116.68	Professional		$17.87	$32.36	$116.68
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.00 / $13.89 / $37.28	Professional	26	$7.00	$13.89	$37.28
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $54.11 / $100.00 / $156.74	Professional	50	$54.11	$100.00	$156.74
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $11.43 / $14.15 / $45.26	Professional	52	$11.43	$14.15	$45.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.89 / $21.92 / $50.92	Professional	TC	$17.89	$21.92	$50.92
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $20.46 / $35.08 / $52.74	Professional		$20.46	$35.08	$52.74
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.41 / $11.31 / $14.90	Professional	26	$6.41	$11.31	$14.90
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $57.98 / $60.05 / $76.89	Professional	50	$57.98	$60.05	$76.89
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $9.32 / $9.32 / $9.32	Professional	52	$9.32	$9.32	$9.32
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $42.00 / $42.00 / $42.00	Professional	TC	$42.00	$42.00	$42.00
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $26.89 / $49.94 / $75.91	Facility		$26.89	$49.94	$75.91
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $25.15 / $36.78 / $74.05	Professional		$25.15	$36.78	$74.05
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.16 / $10.88 / $21.41	Professional	26	$7.16	$10.88	$21.41
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $37.29 / $55.71 / $111.84	Professional	50	$37.29	$55.71	$111.84
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $17.19 / $26.47 / $55.27	Professional	TC	$17.19	$26.47	$55.27
CareSource Facility/Professional Facility Modifier Low / Median / High Price $9.84 / $28.10 / $42.57	Facility		$9.84	$28.10	$42.57
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.16 / $24.84 / $45.61	Professional		$8.16	$24.84	$45.61
Cigna Facility/Professional Facility Modifier Low / Median / High Price $35.40 / $51.94 / $171.35	Facility		$35.40	$51.94	$171.35
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 $26.47 / $26.47 / $26.47	Facility	TC	$26.47	$26.47	$26.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $25.24 / $42.62 / $79.33	Professional		$25.24	$42.62	$79.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.58 / $12.87 / $21.67	Professional	26	$7.58	$12.87	$21.67
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.25 / $31.04 / $56.12	Professional	TC	$18.25	$31.04	$56.12
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $33.45 / $53.33 / $111.84	Professional		$33.45	$53.33	$111.84
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 $27.85 / $27.85 / $39.14	Professional	52	$27.85	$27.85	$39.14
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $24.88 / $39.67 / $83.17	Professional	TC	$24.88	$39.67	$83.17
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $143.54 / $180.13 / $216.37	Facility		$143.54	$180.13	$216.37
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $11.23 / $32.29 / $53.62	Professional		$11.23	$32.29	$53.62
United Facility/Professional Facility Modifier Low / Median / High Price $250.18 / $261.88 / $261.88	Facility		$250.18	$261.88	$261.88
United Facility/Professional Professional Modifier Low / Median / High Price $26.59 / $37.22 / $67.16	Professional		$26.59	$37.22	$67.16
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.36 / $10.40 / $17.87	Professional	26	$7.36	$10.40	$17.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.23 / $25.16 / $47.44	Professional	TC	$18.23	$25.16	$47.44