Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $47.86 / $181.97 / $630.96	Facility		$47.86	$181.97	$630.96
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.24 / $12.30 / $38.02	Facility	26	$7.24	$12.30	$38.02
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $23.99 / $102.33 / $501.19	Facility	TC	$23.99	$102.33	$501.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $9.77 / $39.81 / $125.89	Professional		$9.77	$39.81	$125.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $14.13 / $42.66	Professional	26	$7.41	$14.13	$42.66
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $42.66 / $125.89 / $288.40	Professional	50	$42.66	$125.89	$288.40
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $30.90 / $30.90 / $30.90	Professional	52	$30.90	$30.90	$30.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $39.81 / $79.43	Professional	TC	$21.88	$39.81	$79.43
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $22.91 / $30.90 / $61.66	Professional		$22.91	$30.90	$61.66
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $10.00 / $15.49	Professional	26	$6.46	$10.00	$15.49
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $39.81 / $66.07 / $97.72	Professional	50	$39.81	$66.07	$97.72
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $27.54 / $48.98	Professional	TC	$18.62	$27.54	$48.98
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $31.62 / $53.70 / $93.33	Facility		$31.62	$53.70	$93.33
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $40.74 / $69.18	Professional		$29.51	$40.74	$69.18
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $11.48 / $19.05	Professional	26	$8.32	$11.48	$19.05
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $44.67 / $60.26 / $107.15	Professional	50	$44.67	$60.26	$107.15
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $28.84 / $51.29	Professional	TC	$20.89	$28.84	$51.29
CareSource Facility/Professional Facility Modifier Low / Median / High Price $11.48 / $37.15 / $56.23	Facility		$11.48	$37.15	$56.23
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.51 / $29.51 / $44.67	Professional		$8.51	$29.51	$44.67
Cigna Facility/Professional Facility Modifier Low / Median / High Price $42.66 / $61.66 / $158.49	Facility		$42.66	$61.66	$158.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $45.71 / $85.11	Professional		$28.18	$45.71	$85.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $12.02 / $21.88	Professional	26	$7.59	$12.02	$21.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $33.88 / $66.07	Professional	TC	$20.89	$33.88	$66.07
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $48.98 / $114.82	Professional		$38.02	$48.98	$114.82
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 52 Low / Median / High Price $32.36 / $32.36 / $45.71	Professional	52	$32.36	$32.36	$45.71
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $38.02 / $81.28	Professional	TC	$29.51	$38.02	$81.28
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $1,737.80 / $1,737.80 / $10,232.93	Facility		$1,737.80	$1,737.80	$10,232.93
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $8.91 / $34.67 / $61.66	Professional		$8.91	$34.67	$61.66
United Facility/Professional Facility Modifier Low / Median / High Price $23.44 / $218.78 / $218.78	Facility		$23.44	$218.78	$218.78
United Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $38.90 / $70.79	Professional		$29.51	$38.90	$70.79
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 / $28.18 / $52.48	Professional	TC	$20.89	$28.18	$52.48