Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $50.36 / $66.23 / $208.37	Facility		$50.36	$66.23	$208.37
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.89 / $27.89 / $49.35	Facility	26	$27.89	$27.89	$49.35
Aetna Facility/Professional Professional Modifier Low / Median / High Price $41.01 / $79.31 / $159.22	Professional		$41.01	$79.31	$159.22
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.89 / $34.82 / $71.50	Professional	26	$27.89	$34.82	$71.50
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $50.36 / $63.31 / $334.86	Professional	50	$50.36	$63.31	$334.86
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $19.47 / $26.54 / $67.45	Professional	52	$19.47	$26.54	$67.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.25 / $31.83 / $90.19	Professional	TC	$17.25	$31.83	$90.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $84.68 / $84.68 / $109.23	Professional		$84.68	$84.68	$109.23
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $51.13 / $51.13 / $51.13	Professional	26	$51.13	$51.13	$51.13
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $27.72 / $27.72 / $27.72	Professional	TC	$27.72	$27.72	$27.72
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $45.24 / $76.43 / $134.01	Professional		$45.24	$76.43	$134.01
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $23.29 / $33.71 / $60.24	Professional	26	$23.29	$33.71	$60.24
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $67.86 / $115.71 / $201.01	Professional	50	$67.86	$115.71	$201.01
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $16.80 / $39.02 / $81.00	Professional	TC	$16.80	$39.02	$81.00
CareSource Facility/Professional Facility Modifier Low / Median / High Price $20.17 / $38.56 / $64.70	Facility		$20.17	$38.56	$64.70
CareSource Facility/Professional Professional Modifier Low / Median / High Price $16.23 / $33.97 / $63.47	Professional		$16.23	$33.97	$63.47
Cigna Facility/Professional Facility Modifier Low / Median / High Price $52.57 / $52.57 / $52.57	Facility		$52.57	$52.57	$52.57
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.84 / $33.84 / $33.84	Facility	26	$33.84	$33.84	$33.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $51.82 / $95.24 / $153.88	Professional		$51.82	$95.24	$153.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.78 / $41.25 / $66.76	Professional	26	$26.78	$41.25	$66.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.72 / $51.73 / $94.02	Professional	TC	$23.72	$51.73	$94.02
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $50.17 / $68.42 / $198.09	Professional		$50.17	$68.42	$198.09
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $31.68 / $40.32 / $88.69	Professional	26	$31.68	$40.32	$88.69
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $32.97 / $32.97 / $43.97	Professional	52	$32.97	$32.97	$43.97
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $18.48 / $25.22 / $167.33	Professional	TC	$18.48	$25.22	$167.33
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $229.25 / $229.25 / $303.04	Facility		$229.25	$229.25	$303.04
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $22.53 / $46.82 / $110.90	Professional		$22.53	$46.82	$110.90
United Facility/Professional Professional Modifier Low / Median / High Price $58.46 / $89.44 / $141.41	Professional		$58.46	$89.44	$141.41
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.06 / $38.35 / $61.20	Professional	26	$30.06	$38.35	$61.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.07 / $47.43 / $91.88	Professional	TC	$27.07	$47.43	$91.88