Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $80.01 / $212.98 / $658.75	Facility		$80.01	$212.98	$658.75
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.30 / $32.32 / $142.63	Facility	26	$28.30	$32.32	$142.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $55.36 / $90.09 / $228.53	Professional		$55.36	$90.09	$228.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.01 / $54.76 / $104.68	Professional	26	$28.01	$54.76	$104.68
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $47.82 / $143.16 / $623.52	Professional	50	$47.82	$143.16	$623.52
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $39.71 / $54.25 / $133.43	Professional	TC	$39.71	$54.25	$133.43
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $65.45 / $109.49 / $152.59	Professional		$65.45	$109.49	$152.59
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $26.00 / $44.36 / $64.30	Professional	26	$26.00	$44.36	$64.30
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $98.63 / $164.23 / $228.89	Professional	50	$98.63	$164.23	$228.89
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $35.94 / $42.83 / $58.40	Professional	TC	$35.94	$42.83	$58.40
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $75.00 / $146.00 / $240.93	Facility		$75.00	$146.00	$240.93
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $75.64 / $108.34 / $198.80	Professional		$75.64	$108.34	$198.80
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $28.56 / $38.47 / $75.16	Professional	26	$28.56	$38.47	$75.16
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $113.46 / $162.01 / $298.20	Professional	50	$113.46	$162.01	$298.20
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $45.60 / $60.84 / $123.64	Professional	TC	$45.60	$60.84	$123.64
CareSource Facility/Professional Facility Modifier Low / Median / High Price $40.86 / $67.77 / $152.05	Facility		$40.86	$67.77	$152.05
CareSource Facility/Professional Professional Modifier Low / Median / High Price $32.39 / $57.92 / $105.50	Professional		$32.39	$57.92	$105.50
Cigna Facility/Professional Facility Modifier Low / Median / High Price $81.93 / $116.18 / $240.11	Facility		$81.93	$116.18	$240.11
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.03 / $37.03 / $37.03	Facility	26	$37.03	$37.03	$37.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $83.61 / $126.24 / $221.98	Professional		$83.61	$126.24	$221.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.89 / $48.98 / $86.56	Professional	26	$33.89	$48.98	$86.56
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $51.63 / $77.45 / $135.96	Professional	TC	$51.63	$77.45	$135.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $77.78 / $90.41 / $257.36	Professional		$77.78	$90.41	$257.36
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $31.52 / $39.77 / $99.12	Professional	26	$31.52	$39.77	$99.12
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $50.67 / $60.80 / $158.22	Professional	TC	$50.67	$60.80	$158.22
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $367.42 / $389.83 / $423.64	Facility		$367.42	$389.83	$423.64
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $38.94 / $74.20 / $141.44	Professional		$38.94	$74.20	$141.44
United Facility/Professional Facility Modifier Low / Median / High Price $146.66 / $216.45 / $216.45	Facility		$146.66	$216.45	$216.45
United Facility/Professional Professional Modifier Low / Median / High Price $82.12 / $114.56 / $189.70	Professional		$82.12	$114.56	$189.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.61 / $45.43 / $76.31	Professional	26	$33.61	$45.43	$76.31
United Facility/Professional Professional Modifier TC Low / Median / High Price $50.58 / $71.54 / $119.30	Professional	TC	$50.58	$71.54	$119.30