Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $53.54 / $141.04 / $294.10	Facility		$53.54	$141.04	$294.10
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $88.29 / $146.08 / $383.32	Facility	25	$88.29	$146.08	$383.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.20 / $84.91 / $185.93	Professional		$51.20	$84.91	$185.93
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $53.34 / $86.48 / $194.19	Professional	25	$53.34	$86.48	$194.19
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $254.64 / $262.68 / $271.76	Professional	50	$254.64	$262.68	$271.76
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $61.27 / $85.78 / $126.62	Professional		$61.27	$85.78	$126.62
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $71.94 / $99.33 / $138.81	Professional	25	$71.94	$99.33	$138.81
BCBS Facility/Professional Professional Modifier Low / Median / High Price $64.31 / $98.58 / $149.88	Professional		$64.31	$98.58	$149.88
Cigna Facility/Professional Facility Modifier Low / Median / High Price $88.08 / $120.00 / $150.00	Facility		$88.08	$120.00	$150.00
Cigna Facility/Professional Facility Modifier 62 Low / Median / High Price $55.05 / $55.05 / $55.05	Facility	62	$55.05	$55.05	$55.05
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $8.81 / $8.81 / $8.81	Facility	AS	$8.81	$8.81	$8.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $49.09 / $85.47 / $145.21	Professional		$49.09	$85.47	$145.21
Medcost Facility/Professional Facility Modifier Low / Median / High Price $55.64 / $75.00 / $123.61	Facility		$55.64	$75.00	$123.61
Medcost Facility/Professional Facility Modifier 50 Low / Median / High Price $77.09 / $104.79 / $192.00	Facility	50	$77.09	$104.79	$192.00
Medcost Facility/Professional Facility Modifier 80 Low / Median / High Price $10.28 / $13.97 / $25.60	Facility	80	$10.28	$13.97	$25.60
Medcost Facility/Professional Facility Modifier AS Low / Median / High Price $7.20 / $9.84 / $17.92	Facility	AS	$7.20	$9.84	$17.92
Medcost Facility/Professional Professional Modifier Low / Median / High Price $40.00 / $91.00 / $127.00	Professional		$40.00	$91.00	$127.00
Medcost Facility/Professional Professional Modifier 50 Low / Median / High Price $87.00 / $106.73 / $285.95	Professional	50	$87.00	$106.73	$285.95
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $66.70 / $107.74 / $168.40	Professional		$66.70	$107.74	$168.40
United Facility/Professional Professional Modifier Low / Median / High Price $57.15 / $78.26 / $140.44	Professional		$57.15	$78.26	$140.44
Wellcare Facility/Professional Facility Modifier Low / Median / High Price $170.90 / $323.29 / $323.29	Facility		$170.90	$323.29	$323.29
Wellcare Facility/Professional Facility Modifier 62 Low / Median / High Price $202.06 / $202.06 / $202.06	Facility	62	$202.06	$202.06	$202.06
Wellcare Facility/Professional Facility Modifier AS Low / Median / High Price $32.33 / $32.33 / $32.33	Facility	AS	$32.33	$32.33	$32.33
Wellcare Facility/Professional Professional Modifier Low / Median / High Price $413.45 / $567.54 / $567.54	Professional		$413.45	$567.54	$567.54