Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $81.28 / $218.78 / $676.08	Facility		$81.28	$218.78	$676.08
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.18 / $50.12 / $147.91	Facility	26	$28.18	$50.12	$147.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $102.33 / $436.52	Professional		$54.95	$102.33	$436.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $61.66 / $173.78	Professional	26	$28.18	$61.66	$173.78
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $56.23 / $169.82 / $691.83	Professional	50	$56.23	$169.82	$691.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $56.23 / $144.54	Professional	TC	$41.69	$56.23	$144.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $87.10 / $147.91	Professional		$61.66	$87.10	$147.91
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $39.81 / $60.26	Professional	26	$25.12	$39.81	$60.26
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $91.20 / $138.04 / $229.09	Professional	50	$91.20	$138.04	$229.09
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $45.71 / $53.70	Professional	TC	$37.15	$45.71	$53.70
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $138.04 / $173.78	Facility		$66.07	$138.04	$173.78
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $107.15 / $162.18	Professional		$83.18	$107.15	$162.18
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $38.90 / $61.66	Professional	26	$33.88	$38.90	$61.66
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $123.03 / $158.49 / $245.47	Professional	50	$123.03	$158.49	$245.47
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $60.26 / $97.72	Professional	TC	$53.70	$60.26	$97.72
CareSource Facility/Professional Facility Modifier Low / Median / High Price $43.65 / $69.18 / $123.03	Facility		$43.65	$69.18	$123.03
CareSource Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $56.23 / $104.71	Professional		$33.11	$56.23	$104.71
Cigna Facility/Professional Facility Modifier Low / Median / High Price $79.43 / $117.49 / $229.09	Facility		$79.43	$117.49	$229.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $120.23 / $218.78	Professional		$79.43	$120.23	$218.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $46.77 / $85.11	Professional	26	$32.36	$46.77	$85.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $74.13 / $131.83	Professional	TC	$48.98	$74.13	$131.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $93.33 / $269.15	Professional		$85.11	$93.33	$269.15
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $36.31 / $102.33	Professional	26	$31.62	$36.31	$102.33
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $60.26 / $165.96	Professional	TC	$52.48	$60.26	$165.96
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $354.81 / $354.81 / $1,047.13	Facility		$354.81	$354.81	$1,047.13
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $69.18 / $141.25	Professional		$33.11	$69.18	$141.25
United Facility/Professional Facility Modifier Low / Median / High Price $69.18 / $218.78 / $218.78	Facility		$69.18	$218.78	$218.78
United Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $109.65 / $190.55	Professional		$81.28	$109.65	$190.55
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $42.66 / $72.44	Professional	26	$31.62	$42.66	$72.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $67.61 / $117.49	Professional	TC	$48.98	$67.61	$117.49