Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $35.93 / $339.47 / $470.99	Facility		$35.93	$339.47	$470.99
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.55 / $20.55 / $23.58	Facility	26	$20.55	$20.55	$23.58
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $15.38 / $339.47 / $386.54	Facility	TC	$15.38	$339.47	$386.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $35.93 / $68.61 / $115.00	Professional		$35.93	$68.61	$115.00
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $71.59 / $71.59 / $71.59	Professional	25	$71.59	$71.59	$71.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.39 / $23.01 / $59.47	Professional	26	$20.39	$23.01	$59.47
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $234.74 / $234.74 / $281.35	Professional	50	$234.74	$234.74	$281.35
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $17.97 / $17.97 / $40.33	Professional	52	$17.97	$17.97	$40.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.38 / $28.14 / $97.79	Professional	TC	$15.38	$28.14	$97.79
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $24.00 / $26.52 / $26.67	Professional		$24.00	$26.52	$26.67
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $27.57 / $27.57 / $27.57	Professional	26	$27.57	$27.57	$27.57
BCBS Facility/Professional Professional Modifier Low / Median / High Price $56.25 / $57.75 / $57.75	Professional		$56.25	$57.75	$57.75
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.14 / $39.40 / $53.44	Professional	26	$19.14	$39.40	$53.44
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $14.59 / $63.50 / $101.45	Professional	TC	$14.59	$63.50	$101.45
Cigna Facility/Professional Facility Modifier Low / Median / High Price $41.38 / $41.38 / $41.38	Facility		$41.38	$41.38	$41.38
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.35 / $23.35 / $23.35	Facility	26	$23.35	$23.35	$23.35
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $18.64 / $18.64 / $18.64	Facility	TC	$18.64	$18.64	$18.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $40.58 / $90.92 / $174.28	Professional		$40.58	$90.92	$174.28
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.05 / $34.59 / $60.79	Professional	26	$20.05	$34.59	$60.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.39 / $56.36 / $111.87	Professional	TC	$18.39	$56.36	$111.87
Medcost Facility/Professional Facility Modifier Low / Median / High Price $35.93 / $69.25 / $138.87	Facility		$35.93	$69.25	$138.87
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $23.00 / $23.84 / $48.40	Facility	26	$23.00	$23.84	$48.40
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $14.99 / $46.40 / $102.83	Facility	TC	$14.99	$46.40	$102.83
Medcost Facility/Professional Professional Modifier Low / Median / High Price $28.00 / $55.00 / $82.00	Professional		$28.00	$55.00	$82.00
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $23.00 / $23.84 / $23.84	Professional	26	$23.00	$23.84	$23.84
Medcost Facility/Professional Professional Modifier 50 Low / Median / High Price $102.00 / $103.88 / $198.33	Professional	50	$102.00	$103.88	$198.33
Medcost Facility/Professional Professional Modifier TC Low / Median / High Price $56.60 / $56.60 / $56.60	Professional	TC	$56.60	$56.60	$56.60
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $323.89 / $323.89 / $805.23	Facility		$323.89	$323.89	$805.23
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $24.69 / $37.04 / $96.70	Professional		$24.69	$37.04	$96.70
United Facility/Professional Professional Modifier Low / Median / High Price $36.36 / $54.39 / $138.63	Professional		$36.36	$54.39	$138.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.91 / $24.21 / $54.30	Professional	26	$11.91	$24.21	$54.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.79 / $29.15 / $94.58	Professional	TC	$20.79	$29.15	$94.58
Wellcare Facility/Professional Facility Modifier Low / Median / High Price $92.00 / $232.02 / $232.02	Facility		$92.00	$232.02	$232.02
Wellcare Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $101.79 / $101.79	Facility	26	$100.00	$101.79	$101.79
Wellcare Facility/Professional Facility Modifier TC Low / Median / High Price $92.62 / $141.03 / $141.03	Facility	TC	$92.62	$141.03	$141.03
Wellcare Facility/Professional Professional Modifier Low / Median / High Price $414.44 / $414.44 / $414.44	Professional		$414.44	$414.44	$414.44
Wellcare Facility/Professional Professional Modifier 26 Low / Median / High Price $130.60 / $130.60 / $163.95	Professional	26	$130.60	$130.60	$163.95
Wellcare Facility/Professional Professional Modifier TC Low / Median / High Price $293.07 / $293.07 / $293.07	Professional	TC	$293.07	$293.07	$293.07