Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $33.79 / $114.75 / $399.90	Facility		$33.79	$114.75	$399.90
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.41 / $11.01 / $32.67	Facility	26	$6.41	$11.01	$32.67
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $17.82 / $49.36 / $408.54	Facility	TC	$17.82	$49.36	$408.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $17.55 / $34.02 / $110.10	Professional		$17.55	$34.02	$110.10
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.36 / $12.07 / $34.02	Professional	26	$6.36	$12.07	$34.02
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $84.00 / $111.98 / $269.82	Professional	50	$84.00	$111.98	$269.82
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $10.45 / $12.29 / $38.21	Professional	52	$10.45	$12.29	$38.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.39 / $21.31 / $47.31	Professional	TC	$16.39	$21.31	$47.31
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $18.55 / $35.76 / $51.08	Professional		$18.55	$35.76	$51.08
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.75 / $10.46 / $13.31	Professional	26	$5.75	$10.46	$13.31
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $54.46 / $54.46 / $162.49	Professional	50	$54.46	$54.46	$162.49
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $33.54 / $34.51 / $36.04	Professional	TC	$33.54	$34.51	$36.04
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $26.38 / $46.50 / $68.31	Facility		$26.38	$46.50	$68.31
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $24.52 / $35.21 / $69.55	Professional		$24.52	$35.21	$69.55
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.09 / $10.19 / $20.00	Professional	26	$7.09	$10.19	$20.00
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $36.78 / $53.01 / $104.32	Professional	50	$36.78	$53.01	$104.32
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $16.76 / $24.39 / $49.90	Professional	TC	$16.76	$24.39	$49.90
CareSource Facility/Professional Facility Modifier Low / Median / High Price $9.07 / $25.30 / $38.51	Facility		$9.07	$25.30	$38.51
CareSource Facility/Professional Professional Modifier Low / Median / High Price $7.50 / $22.35 / $41.09	Professional		$7.50	$22.35	$41.09
Cigna Facility/Professional Facility Modifier Low / Median / High Price $32.07 / $46.82 / $136.00	Facility		$32.07	$46.82	$136.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.51 / $8.51 / $8.51	Facility	26	$8.51	$8.51	$8.51
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $23.86 / $23.86 / $23.86	Facility	TC	$23.86	$23.86	$23.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $23.47 / $40.32 / $71.70	Professional		$23.47	$40.32	$71.70
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.20 / $11.95 / $20.10	Professional	26	$7.20	$11.95	$20.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.73 / $29.65 / $52.22	Professional	TC	$17.73	$29.65	$52.22
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $30.26 / $48.24 / $101.15	Professional		$30.26	$48.24	$101.15
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $7.87 / $12.54 / $27.03	Professional	26	$7.87	$12.54	$27.03
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $25.20 / $25.20 / $35.40	Professional	52	$25.20	$25.20	$35.40
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $22.40 / $35.70 / $74.87	Professional	TC	$22.40	$35.70	$74.87
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $145.84 / $175.19 / $574.16	Facility		$145.84	$175.19	$574.16
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $10.30 / $29.32 / $49.25	Professional		$10.30	$29.32	$49.25
United Facility/Professional Professional Modifier Low / Median / High Price $25.25 / $33.72 / $60.42	Professional		$25.25	$33.72	$60.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.28 / $9.94 / $16.89	Professional	26	$7.28	$9.94	$16.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.89 / $24.20 / $44.24	Professional	TC	$17.89	$24.20	$44.24