Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.81 / $85.61 / $126.00	Facility	26	$69.81	$85.61	$126.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $236.41 / $425.00 / $1,253.75	Professional		$236.41	$425.00	$1,253.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.81 / $118.59 / $263.00	Professional	26	$69.81	$118.59	$263.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $118.21 / $126.45 / $300.00	Professional	52	$118.21	$126.45	$300.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $166.60 / $335.00 / $603.67	Professional	TC	$166.60	$335.00	$603.67
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $171.76 / $581.96 / $581.96	Professional		$171.76	$581.96	$581.96
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $51.78 / $82.21 / $145.37	Professional	26	$51.78	$82.21	$145.37
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $302.52 / $381.06 / $381.06	Professional	TC	$302.52	$381.06	$381.06
BCBS Facility/Professional Professional Modifier Low / Median / High Price $181.45 / $181.45 / $181.45	Professional		$181.45	$181.45	$181.45
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $111.87 / $163.74 / $210.25	Professional	26	$111.87	$163.74	$210.25
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $430.94 / $667.48 / $897.07	Professional	TC	$430.94	$667.48	$897.07
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.45 / $79.45 / $79.45	Facility	26	$79.45	$79.45	$79.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $318.07 / $620.48 / $1,195.01	Professional		$318.07	$620.48	$1,195.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.86 / $114.29 / $200.41	Professional	26	$66.86	$114.29	$200.41
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $226.82 / $484.48 / $1,018.62	Professional	TC	$226.82	$484.48	$1,018.62
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $105.26 / $120.00 / $215.35	Facility	26	$105.26	$120.00	$215.35
Medcost Facility/Professional Professional Modifier Low / Median / High Price $93.00 / $375.00 / $468.00	Professional		$93.00	$375.00	$468.00
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $105.26 / $105.26 / $120.00	Professional	26	$105.26	$105.26	$120.00
Medcost Facility/Professional Professional Modifier TC Low / Median / High Price $613.09 / $613.09 / $613.09	Professional	TC	$613.09	$613.09	$613.09
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $86.41 / $213.75 / $381.54	Professional		$86.41	$213.75	$381.54
United Facility/Professional Professional Modifier Low / Median / High Price $254.45 / $489.58 / $891.85	Professional		$254.45	$489.58	$891.85
United Facility/Professional Professional Modifier 26 Low / Median / High Price $70.20 / $95.00 / $207.83	Professional	26	$70.20	$95.00	$207.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $185.79 / $380.13 / $709.65	Professional	TC	$185.79	$380.13	$709.65
Wellcare Facility/Professional Facility Modifier 26 Low / Median / High Price $502.88 / $632.64 / $632.64	Facility	26	$502.88	$632.64	$632.64
Wellcare Facility/Professional Professional Modifier Low / Median / High Price $2,918.81 / $3,612.22 / $3,612.22	Professional		$2,918.81	$3,612.22	$3,612.22
Wellcare Facility/Professional Professional Modifier 26 Low / Median / High Price $571.29 / $571.29 / $571.29	Professional	26	$571.29	$571.29	$571.29
Wellcare Facility/Professional Professional Modifier TC Low / Median / High Price $2,539.44 / $2,545.16 / $2,545.16	Professional	TC	$2,539.44	$2,545.16	$2,545.16