Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $44.73 / $177.45 / $544.32	Facility		$44.73	$177.45	$544.32
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.30 / $10.97 / $36.01	Facility	26	$7.30	$10.97	$36.01
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $24.07 / $190.62 / $522.26	Facility	TC	$24.07	$190.62	$522.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $8.73 / $36.42 / $121.00	Professional		$8.73	$36.42	$121.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.30 / $13.61 / $40.04	Professional	26	$7.30	$13.61	$40.04
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $57.64 / $126.54 / $319.26	Professional	50	$57.64	$126.54	$319.26
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $13.41 / $15.63 / $38.15	Professional	52	$13.41	$15.63	$38.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.94 / $28.83 / $69.97	Professional	TC	$21.94	$28.83	$69.97
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $27.14 / $50.39 / $65.45	Professional		$27.14	$50.39	$65.45
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.68 / $11.79 / $15.08	Professional	26	$6.68	$11.79	$15.08
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $62.26 / $90.75 / $98.17	Professional	50	$62.26	$90.75	$98.17
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $42.81 / $46.69 / $51.82	Professional	TC	$42.81	$46.69	$51.82
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $31.22 / $57.89 / $93.25	Facility		$31.22	$57.89	$93.25
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $28.27 / $41.62 / $85.71	Professional		$28.27	$41.62	$85.71
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $11.40 / $22.33	Professional	26	$7.76	$11.40	$22.33
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $42.30 / $63.52 / $128.56	Professional	50	$42.30	$63.52	$128.56
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $20.72 / $31.68 / $65.06	Professional	TC	$20.72	$31.68	$65.06
CareSource Facility/Professional Facility Modifier Low / Median / High Price $10.27 / $33.70 / $49.35	Facility		$10.27	$33.70	$49.35
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.51 / $29.80 / $53.84	Professional		$8.51	$29.80	$53.84
Cigna Facility/Professional Facility Modifier Low / Median / High Price $41.01 / $62.15 / $136.00	Facility		$41.01	$62.15	$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 $31.68 / $31.68 / $31.68	Facility	TC	$31.68	$31.68	$31.68
Cigna Facility/Professional Professional Modifier Low / Median / High Price $29.10 / $50.32 / $88.64	Professional		$29.10	$50.32	$88.64
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 $21.52 / $37.08 / $68.92	Professional	TC	$21.52	$37.08	$68.92
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $38.78 / $61.81 / $129.63	Professional		$38.78	$61.81	$129.63
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 52 Low / Median / High Price $32.29 / $32.29 / $45.37	Professional	52	$32.29	$32.29	$45.37
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $29.84 / $47.58 / $99.77	Professional	TC	$29.84	$47.58	$99.77
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $1,663.61 / $2,164.00 / $2,706.90	Facility		$1,663.61	$2,164.00	$2,706.90
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $11.42 / $38.22 / $64.14	Professional		$11.42	$38.22	$64.14
United Facility/Professional Facility Modifier Low / Median / High Price $21.57 / $179.57 / $216.45	Facility		$21.57	$179.57	$216.45
United Facility/Professional Professional Modifier Low / Median / High Price $30.30 / $42.44 / $75.30	Professional		$30.30	$42.44	$75.30
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.95 / $10.82 / $19.23	Professional	26	$7.95	$10.82	$19.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.64 / $31.55 / $57.66	Professional	TC	$21.64	$31.55	$57.66