Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $94.44 / $246.29 / $998.75	Facility		$94.44	$246.29	$998.75
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.50 / $35.35 / $123.31	Facility	26	$24.50	$35.35	$123.31
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $53.50 / $225.51 / $868.27	Facility	TC	$53.50	$225.51	$868.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $73.90 / $107.68 / $234.69	Professional		$73.90	$107.68	$234.69
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.91 / $32.76 / $76.68	Professional	26	$23.91	$32.76	$76.68
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $49.43 / $80.89 / $171.56	Professional	TC	$49.43	$80.89	$171.56
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $66.70 / $134.41 / $156.10	Professional		$66.70	$134.41	$156.10
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $20.74 / $37.95 / $51.47	Professional	26	$20.74	$37.95	$51.47
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $52.24 / $98.23 / $106.05	Professional	TC	$52.24	$98.23	$106.05
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $83.76 / $166.20 / $250.52	Facility		$83.76	$166.20	$250.52
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $78.03 / $114.09 / $220.63	Professional		$78.03	$114.09	$220.63
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $24.78 / $37.32 / $66.52	Professional	26	$24.78	$37.32	$66.52
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $51.40 / $77.28 / $152.76	Professional	TC	$51.40	$77.28	$152.76
CareSource Facility/Professional Facility Modifier Low / Median / High Price $34.15 / $72.81 / $117.69	Facility		$34.15	$72.81	$117.69
CareSource Facility/Professional Professional Modifier Low / Median / High Price $27.75 / $60.81 / $114.77	Professional		$27.75	$60.81	$114.77
Cigna Facility/Professional Facility Modifier Low / Median / High Price $85.68 / $130.79 / $248.00	Facility		$85.68	$130.79	$248.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.67 / $31.67 / $31.67	Facility	26	$31.67	$31.67	$31.67
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $66.73 / $66.73 / $66.73	Facility	TC	$66.73	$66.73	$66.73
Cigna Facility/Professional Professional Modifier Low / Median / High Price $85.98 / $134.62 / $226.33	Professional		$85.98	$134.62	$226.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.26 / $42.19 / $73.98	Professional	26	$27.26	$42.19	$73.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $56.89 / $92.15 / $155.66	Professional	TC	$56.89	$92.15	$155.66
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $84.08 / $107.53 / $269.83	Professional		$84.08	$107.53	$269.83
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $26.95 / $35.04 / $85.84	Professional	26	$26.95	$35.04	$85.84
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $57.12 / $70.88 / $229.68	Professional	TC	$57.12	$70.88	$229.68
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $114.62 / $183.00 / $210.47	Facility		$114.62	$183.00	$210.47
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $34.97 / $82.46 / $144.06	Professional		$34.97	$82.46	$144.06
United Facility/Professional Facility Modifier Low / Median / High Price $153.82 / $252.18 / $252.18	Facility		$153.82	$252.18	$252.18
United Facility/Professional Professional Modifier Low / Median / High Price $86.12 / $121.42 / $197.36	Professional		$86.12	$121.42	$197.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.30 / $37.52 / $65.65	Professional	26	$28.30	$37.52	$65.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $57.51 / $81.47 / $133.57	Professional	TC	$57.51	$81.47	$133.57