Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $41.81 / $190.68 / $400.09	Facility		$41.81	$190.68	$400.09
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.04 / $94.00 / $132.25	Facility	26	$26.04	$94.00	$132.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $40.32 / $82.23 / $178.02	Professional		$40.32	$82.23	$178.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.57 / $45.34 / $111.01	Professional	26	$25.57	$45.34	$111.01
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $76.23 / $146.47 / $316.70	Professional	50	$76.23	$146.47	$316.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $14.11 / $22.53 / $83.89	Professional	TC	$14.11	$22.53	$83.89
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $79.20 / $79.20 / $79.20	Professional		$79.20	$79.20	$79.20
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $49.51 / $53.29 / $53.29	Professional	26	$49.51	$53.29	$53.29
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $118.82 / $118.82 / $118.82	Professional	50	$118.82	$118.82	$118.82
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $34.50 / $64.94 / $216.34	Facility		$34.50	$64.94	$216.34
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $45.04 / $90.87 / $163.74	Professional		$45.04	$90.87	$163.74
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $26.35 / $51.59 / $88.25	Professional	26	$26.35	$51.59	$88.25
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $67.56 / $134.58 / $245.62	Professional	50	$67.56	$134.58	$245.62
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $16.52 / $35.96 / $83.17	Professional	TC	$16.52	$35.96	$83.17
CareSource Facility/Professional Facility Modifier Low / Median / High Price $20.56 / $39.06 / $65.67	Facility		$20.56	$39.06	$65.67
CareSource Facility/Professional Professional Modifier Low / Median / High Price $16.55 / $34.61 / $64.34	Professional		$16.55	$34.61	$64.34
Cigna Facility/Professional Facility Modifier Low / Median / High Price $28.25 / $39.51 / $240.11	Facility		$28.25	$39.51	$240.11
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.29 / $34.29 / $34.29	Facility	26	$34.29	$34.29	$34.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $55.89 / $113.33 / $209.94	Professional		$55.89	$113.33	$209.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.31 / $60.88 / $101.68	Professional	26	$35.31	$60.88	$101.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.86 / $46.79 / $95.27	Professional	TC	$22.86	$46.79	$95.27
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $46.26 / $60.14 / $328.06	Professional		$46.26	$60.14	$328.06
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $29.12 / $37.86 / $126.65	Professional	26	$29.12	$37.86	$126.65
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $17.13 / $21.31 / $290.72	Professional	TC	$17.13	$21.31	$290.72
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $118.40 / $157.19 / $211.50	Professional		$118.40	$157.19	$211.50
United Facility/Professional Facility Modifier Low / Median / High Price $250.18 / $261.88 / $261.88	Facility		$250.18	$261.88	$261.88
United Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $102.03 / $188.20	Professional		$53.70	$102.03	$188.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.83 / $54.57 / $87.19	Professional	26	$30.83	$54.57	$87.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.29 / $40.07 / $85.10	Professional	TC	$19.29	$40.07	$85.10