Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $70.51 / $80.75 / $126.00	Facility	26	$70.51	$80.75	$126.00
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $40.03 / $70.68 / $116.66	Facility	53	$40.03	$70.68	$116.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $200.17 / $400.00 / $1,168.92	Professional		$200.17	$400.00	$1,168.92
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.55 / $115.79 / $322.00	Professional	26	$68.55	$115.79	$322.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $100.09 / $120.07 / $300.00	Professional	52	$100.09	$120.07	$300.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $129.66 / $281.41 / $454.55	Professional	TC	$129.66	$281.41	$454.55
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $172.59 / $196.45 / $497.17	Professional		$172.59	$196.45	$497.17
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.20 / $101.09 / $146.81	Professional	26	$52.20	$101.09	$146.81
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $93.32 / $181.84 / $207.75	Professional	TC	$93.32	$181.84	$207.75
BCBS Facility/Professional Professional Modifier Low / Median / High Price $185.35 / $185.35 / $185.35	Professional		$185.35	$185.35	$185.35
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $116.58 / $177.27 / $213.29	Professional	26	$116.58	$177.27	$213.29
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $413.78 / $654.39 / $893.21	Professional	TC	$413.78	$654.39	$893.21
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.26 / $80.26 / $80.26	Facility	26	$80.26	$80.26	$80.26
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $45.11 / $45.11 / $45.11	Facility	53	$45.11	$45.11	$45.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $262.23 / $550.47 / $1,180.95	Professional		$262.23	$550.47	$1,180.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.73 / $115.18 / $203.52	Professional	26	$67.73	$115.18	$203.52
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $169.86 / $405.01 / $1,026.21	Professional	TC	$169.86	$405.01	$1,026.21
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $106.46 / $144.00 / $260.00	Facility	26	$106.46	$144.00	$260.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $94.00 / $195.00 / $450.00	Professional		$94.00	$195.00	$450.00
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $106.46 / $106.46 / $144.00	Professional	26	$106.46	$106.46	$144.00
Medcost Facility/Professional Professional Modifier TC Low / Median / High Price $477.19 / $477.19 / $477.19	Professional	TC	$477.19	$477.19	$477.19
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $71.69 / $190.28 / $334.28	Professional		$71.69	$190.28	$334.28
United Facility/Professional Professional Modifier Low / Median / High Price $213.89 / $427.97 / $683.57	Professional		$213.89	$427.97	$683.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.62 / $95.94 / $203.67	Professional	26	$69.62	$95.94	$203.67
United Facility/Professional Professional Modifier TC Low / Median / High Price $140.32 / $284.01 / $559.66	Professional	TC	$140.32	$284.01	$559.66
Wellcare Facility/Professional Facility Modifier 26 Low / Median / High Price $507.76 / $638.88 / $638.88	Facility	26	$507.76	$638.88	$638.88
Wellcare Facility/Professional Facility Modifier 53 Low / Median / High Price $85.26 / $285.58 / $285.58	Facility	53	$85.26	$285.58	$285.58
Wellcare Facility/Professional Professional Modifier Low / Median / High Price $2,958.99 / $2,958.99 / $2,958.99	Professional		$2,958.99	$2,958.99	$2,958.99
Wellcare Facility/Professional Professional Modifier 26 Low / Median / High Price $584.49 / $584.49 / $584.49	Professional	26	$584.49	$584.49	$584.49
Wellcare Facility/Professional Professional Modifier TC Low / Median / High Price $2,573.94 / $2,573.94 / $2,573.94	Professional	TC	$2,573.94	$2,573.94	$2,573.94