Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $37.34 / $118.70 / $494.15	Facility		$37.34	$118.70	$494.15
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.34 / $10.84 / $47.54	Facility	26	$9.34	$10.84	$47.54
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $25.71 / $71.22 / $521.63	Facility	TC	$25.71	$71.22	$521.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.60 / $45.11 / $105.30	Professional		$33.60	$45.11	$105.30
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.11 / $13.62 / $30.07	Professional	26	$9.11	$13.62	$30.07
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $70.50 / $118.99 / $195.18	Professional	50	$70.50	$118.99	$195.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.71 / $28.28 / $67.27	Professional	TC	$23.71	$28.28	$67.27
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $30.78 / $54.62 / $70.58	Professional		$30.78	$54.62	$70.58
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.36 / $13.57 / $19.27	Professional	26	$8.36	$13.57	$19.27
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $27.14 / $27.14 / $52.59	Professional	TC	$27.14	$27.14	$52.59
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $38.11 / $70.23 / $99.77	Facility		$38.11	$70.23	$99.77
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $36.18 / $46.27 / $97.41	Professional		$36.18	$46.27	$97.41
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.29 / $13.84 / $26.28	Professional	26	$10.29	$13.84	$26.28
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $54.13 / $69.40 / $146.38	Professional	50	$54.13	$69.40	$146.38
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $25.52 / $34.29 / $71.58	Professional	TC	$25.52	$34.29	$71.58
CareSource Facility/Professional Facility Modifier Low / Median / High Price $13.13 / $36.90 / $56.14	Facility		$13.13	$36.90	$56.14
CareSource Facility/Professional Professional Modifier Low / Median / High Price $10.96 / $32.64 / $59.81	Professional		$10.96	$32.64	$59.81
Cigna Facility/Professional Facility Modifier Low / Median / High Price $46.23 / $67.28 / $171.35	Facility		$46.23	$67.28	$171.35
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.30 / $12.30 / $12.30	Facility	26	$12.30	$12.30	$12.30
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $34.29 / $34.29 / $34.29	Facility	TC	$34.29	$34.29	$34.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $37.47 / $59.99 / $108.19	Professional		$37.47	$59.99	$108.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.28 / $17.71 / $30.34	Professional	26	$11.28	$17.71	$30.34
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.52 / $42.28 / $78.11	Professional	TC	$26.52	$42.28	$78.11
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $44.11 / $70.31 / $340.00	Professional		$44.11	$70.31	$340.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $11.42 / $18.20 / $91.71	Professional	26	$11.42	$18.20	$91.71
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $36.72 / $36.72 / $51.60	Professional	52	$36.72	$36.72	$51.60
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $32.68 / $52.10 / $238.00	Professional	TC	$32.68	$52.10	$238.00
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $180.13 / $216.37 / $287.08	Facility		$180.13	$216.37	$287.08
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $14.55 / $42.10 / $69.90	Professional		$14.55	$42.10	$69.90
United Facility/Professional Professional Modifier Low / Median / High Price $36.76 / $50.54 / $88.51	Professional		$36.76	$50.54	$88.51
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.91 / $14.95 / $25.32	Professional	26	$10.91	$14.95	$25.32
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.87 / $35.01 / $63.19	Professional	TC	$26.87	$35.01	$63.19