Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $97.72 / $194.98 / $398.11	Facility		$97.72	$194.98	$398.11
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.23 / $83.18 / $141.25	Facility	26	$56.23	$83.18	$141.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $83.18 / $186.21	Professional		$40.74	$83.18	$186.21
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $44.67 / $134.90	Professional	26	$25.12	$44.67	$134.90
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $75.86 / $147.91 / $346.74	Professional	50	$75.86	$147.91	$346.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $14.13 / $21.88 / $64.57	Professional	TC	$14.13	$21.88	$64.57
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $43.65 / $85.11	Professional		$34.67	$43.65	$85.11
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $56.23 / $69.18	Professional	26	$50.12	$56.23	$69.18
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $51.29 / $60.26 / $263.03	Professional	50	$51.29	$60.26	$263.03
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $29.51 / $57.54 / $120.23	Facility		$29.51	$57.54	$120.23
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $107.15 / $190.55	Professional		$61.66	$107.15	$190.55
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $57.54 / $91.20	Professional	26	$35.48	$57.54	$91.20
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $91.20 / $162.18 / $288.40	Professional	50	$91.20	$162.18	$288.40
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $46.77 / $114.82	Professional	TC	$22.91	$46.77	$114.82
CareSource Facility/Professional Facility Modifier Low / Median / High Price $21.88 / $41.69 / $70.79	Facility		$21.88	$41.69	$70.79
CareSource Facility/Professional Professional Modifier Low / Median / High Price $16.60 / $34.67 / $60.26	Professional		$16.60	$34.67	$60.26
Cigna Facility/Professional Facility Modifier Low / Median / High Price $28.18 / $39.81 / $239.88	Facility		$28.18	$39.81	$239.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $112.20 / $186.21	Professional		$52.48	$112.20	$186.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $58.88 / $100.00	Professional	26	$31.62	$58.88	$100.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $46.77 / $87.10	Professional	TC	$20.89	$46.77	$87.10
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $58.88 / $331.13	Professional		$48.98	$58.88	$331.13
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $37.15 / $125.89	Professional	26	$30.90	$37.15	$125.89
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $22.39 / $154.88	Professional	TC	$18.62	$22.39	$154.88
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $125.89 / $229.09	Professional		$83.18	$125.89	$229.09
United Facility/Professional Facility Modifier Low / Median / High Price $41.69 / $263.03 / $263.03	Facility		$41.69	$263.03	$263.03
United Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $93.33 / $158.49	Professional		$50.12	$93.33	$158.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $53.70 / $85.11	Professional	26	$30.20	$53.70	$85.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $38.90 / $81.28	Professional	TC	$19.50	$38.90	$81.28