Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $99.76 / $452.57 / $743.94	Facility		$99.76	$452.57	$743.94
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.57 / $38.50 / $58.61	Facility	26	$31.57	$38.50	$58.61
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $67.40 / $360.34 / $651.20	Facility	TC	$67.40	$360.34	$651.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $96.00 / $133.18 / $535.29	Professional		$96.00	$133.18	$535.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.57 / $39.85 / $141.47	Professional	26	$31.57	$39.85	$141.47
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $44.80 / $48.00 / $85.89	Professional	52	$44.80	$48.00	$85.89
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $64.42 / $87.95 / $180.04	Professional	TC	$64.42	$87.95	$180.04
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $77.83 / $93.26 / $265.81	Professional		$77.83	$93.26	$265.81
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.85 / $38.78 / $70.76	Professional	26	$25.85	$38.78	$70.76
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $53.55 / $77.05 / $98.41	Professional	TC	$53.55	$77.05	$98.41
BCBS Facility/Professional Facility Modifier Low / Median / High Price $216.52 / $259.82 / $325.68	Facility		$216.52	$259.82	$325.68
BCBS Facility/Professional Professional Modifier Low / Median / High Price $93.10 / $93.10 / $93.10	Professional		$93.10	$93.10	$93.10
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $52.14 / $78.80 / $106.24	Professional	26	$52.14	$78.80	$106.24
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $113.68 / $175.73 / $240.84	Professional	TC	$113.68	$175.73	$240.84
Cigna Facility/Professional Facility Modifier Low / Median / High Price $107.37 / $130.55 / $250.52	Facility		$107.37	$130.55	$250.52
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.13 / $40.13 / $40.13	Facility	26	$40.13	$40.13	$40.13
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $82.40 / $82.40 / $82.40	Facility	TC	$82.40	$82.40	$82.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.12 / $163.26 / $292.64	Professional		$114.12	$163.26	$292.64
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.79 / $54.07 / $93.19	Professional	26	$33.79	$54.07	$93.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $76.80 / $111.22 / $197.98	Professional	TC	$76.80	$111.22	$197.98
Medcost Facility/Professional Facility Modifier Low / Median / High Price $98.01 / $177.92 / $265.00	Facility		$98.01	$177.92	$265.00
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $52.98 / $72.00 / $99.00	Facility	26	$52.98	$72.00	$99.00
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $83.29 / $124.85 / $199.95	Facility	TC	$83.29	$124.85	$199.95
Medcost Facility/Professional Professional Modifier Low / Median / High Price $47.00 / $139.00 / $392.55	Professional		$47.00	$139.00	$392.55
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $52.98 / $72.00 / $129.13	Professional	26	$52.98	$72.00	$129.13
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $43.54 / $101.47 / $178.77	Professional		$43.54	$101.47	$178.77
United Facility/Professional Facility Modifier Low / Median / High Price $142.74 / $142.74 / $142.74	Facility		$142.74	$142.74	$142.74
United Facility/Professional Professional Modifier Low / Median / High Price $105.64 / $140.54 / $294.13	Professional		$105.64	$140.54	$294.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.78 / $45.58 / $89.64	Professional	26	$32.78	$45.58	$89.64
United Facility/Professional Professional Modifier TC Low / Median / High Price $72.09 / $94.62 / $198.43	Professional	TC	$72.09	$94.62	$198.43
Wellcare Facility/Professional Facility Modifier Low / Median / High Price $245.42 / $570.62 / $570.62	Facility		$245.42	$570.62	$570.62
Wellcare Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $170.43 / $170.43	Facility	26	$100.00	$170.43	$170.43
Wellcare Facility/Professional Facility Modifier TC Low / Median / High Price $155.00 / $400.24 / $400.24	Facility	TC	$155.00	$400.24	$400.24
Wellcare Facility/Professional Professional Modifier Low / Median / High Price $704.47 / $704.47 / $902.70	Professional		$704.47	$704.47	$902.70
Wellcare Facility/Professional Professional Modifier 26 Low / Median / High Price $290.60 / $290.60 / $290.60	Professional	26	$290.60	$290.60	$290.60
Wellcare Facility/Professional Professional Modifier TC Low / Median / High Price $483.33 / $483.33 / $621.90	Professional	TC	$483.33	$483.33	$621.90