Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $96.64 / $450.68 / $1,354.32	Facility		$96.64	$450.68	$1,354.32
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.87 / $23.37 / $76.50	Facility	26	$19.87	$23.37	$76.50
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $94.40 / $223.39 / $880.44	Facility	TC	$94.40	$223.39	$880.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $21.66 / $125.70 / $293.81	Professional		$21.66	$125.70	$293.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.77 / $25.55 / $86.69	Professional	26	$19.77	$25.55	$86.69
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $90.83 / $108.47 / $214.90	Professional	TC	$90.83	$108.47	$214.90
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $87.72 / $148.75 / $212.43	Professional		$87.72	$148.75	$212.43
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $16.70 / $29.74 / $38.52	Professional	26	$16.70	$29.74	$38.52
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $166.82 / $166.82 / $166.82	Professional	TC	$166.82	$166.82	$166.82
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $141.16 / $308.39 / $364.17	Facility		$141.16	$308.39	$364.17
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $102.97 / $160.03 / $336.63	Professional		$102.97	$160.03	$336.63
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $18.55 / $28.06 / $52.67	Professional	26	$18.55	$28.06	$52.67
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $84.30 / $131.09 / $251.69	Professional	TC	$84.30	$131.09	$251.69
CareSource Facility/Professional Facility Modifier Low / Median / High Price $25.64 / $116.98 / $160.19	Facility		$25.64	$116.98	$160.19
CareSource Facility/Professional Professional Modifier Low / Median / High Price $20.77 / $95.48 / $159.00	Professional		$20.77	$95.48	$159.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $133.10 / $220.44 / $304.05	Facility		$133.10	$220.44	$304.05
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.98 / $23.98 / $39.61	Facility	26	$23.98	$23.98	$39.61
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $109.98 / $109.98 / $109.98	Facility	TC	$109.98	$109.98	$109.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $118.18 / $180.50 / $323.70	Professional		$118.18	$180.50	$323.70
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.72 / $30.42 / $56.80	Professional	26	$21.72	$30.42	$56.80
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $95.95 / $152.55 / $276.16	Professional	TC	$95.95	$152.55	$276.16
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $125.86 / $171.63 / $387.37	Professional		$125.86	$171.63	$387.37
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $22.19 / $30.26 / $162.10	Professional	26	$22.19	$30.26	$162.10
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $103.68 / $141.38 / $334.14	Professional	TC	$103.68	$141.38	$334.14
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $2,123.17 / $2,379.21 / $2,932.00	Facility		$2,123.17	$2,379.21	$2,932.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $21.18 / $108.49 / $188.79	Professional		$21.18	$108.49	$188.79
United Facility/Professional Professional Modifier Low / Median / High Price $122.15 / $185.88 / $308.38	Professional		$122.15	$185.88	$308.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.63 / $30.75 / $51.88	Professional	26	$22.63	$30.75	$51.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $98.20 / $146.76 / $261.50	Professional	TC	$98.20	$146.76	$261.50