Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $35.79 / $169.92 / $930.80	Facility		$35.79	$169.92	$930.80
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.66 / $20.22 / $60.93	Facility	26	$11.66	$20.22	$60.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $37.57 / $78.20	Professional		$28.84	$37.57	$78.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.84 / $14.64 / $37.46	Professional	26	$10.84	$14.64	$37.46
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.87 / $22.31 / $45.36	Professional	TC	$17.87	$22.31	$45.36
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $31.65 / $59.89 / $69.14	Professional		$31.65	$59.89	$69.14
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.81 / $22.26 / $24.15	Professional	26	$10.81	$22.26	$24.15
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $30.19 / $57.22 / $82.40	Facility		$30.19	$57.22	$82.40
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $31.29 / $44.92 / $89.83	Professional		$31.29	$44.92	$89.83
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.57 / $18.55 / $34.17	Professional	26	$12.57	$18.55	$34.17
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $17.07 / $27.58 / $56.15	Professional	TC	$17.07	$27.58	$56.15
CareSource Facility/Professional Facility Modifier Low / Median / High Price $16.55 / $30.87 / $52.07	Facility		$16.55	$30.87	$52.07
CareSource Facility/Professional Professional Modifier Low / Median / High Price $13.64 / $29.67 / $48.82	Professional		$13.64	$29.67	$48.82
Cigna Facility/Professional Facility Modifier Low / Median / High Price $16.77 / $42.87 / $316.00	Facility		$16.77	$42.87	$316.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.88 / $15.88 / $15.88	Facility	26	$15.88	$15.88	$15.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.71 / $53.56 / $91.25	Professional		$32.71	$53.56	$91.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.19 / $20.91 / $36.82	Professional	26	$14.19	$20.91	$36.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.55 / $29.83 / $59.36	Professional	TC	$17.55	$29.83	$59.36
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $37.24 / $44.49 / $97.43	Professional		$37.24	$44.49	$97.43
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $13.01 / $16.54 / $41.18	Professional	26	$13.01	$16.54	$41.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $24.23 / $27.95 / $92.14	Professional	TC	$24.23	$27.95	$92.14
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $3,725.00 / $3,725.00 / $14,734.98	Facility		$3,725.00	$3,725.00	$14,734.98
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $14.96 / $32.01 / $62.89	Professional		$14.96	$32.01	$62.89
United Facility/Professional Professional Modifier Low / Median / High Price $34.32 / $44.53 / $79.26	Professional		$34.32	$44.53	$79.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.22 / $19.89 / $31.10	Professional	26	$14.22	$19.89	$31.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.89 / $25.23 / $48.98	Professional	TC	$19.89	$25.23	$48.98