Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $65.04 / $75.06 / $126.00	Facility	26	$65.04	$75.06	$126.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $206.59 / $400.00 / $1,064.80	Professional		$206.59	$400.00	$1,064.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.94 / $126.00 / $288.70	Professional	26	$64.94	$126.00	$288.70
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $288.70 / $288.70 / $1,218.00	Professional	50	$288.70	$288.70	$1,218.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $103.30 / $123.88 / $300.00	Professional	52	$103.30	$123.88	$300.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $141.55 / $308.63 / $646.48	Professional	TC	$141.55	$308.63	$646.48
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $203.23 / $376.36 / $513.34	Professional		$203.23	$376.36	$513.34
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $47.62 / $69.02 / $134.84	Professional	26	$47.62	$69.02	$134.84
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $102.60 / $210.15 / $210.15	Professional	TC	$102.60	$210.15	$210.15
BCBS Facility/Professional Professional Modifier Low / Median / High Price $167.12 / $167.12 / $167.12	Professional		$167.12	$167.12	$167.12
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $103.62 / $151.53 / $194.09	Professional	26	$103.62	$151.53	$194.09
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $404.11 / $604.72 / $898.01	Professional	TC	$404.11	$604.72	$898.01
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $73.64 / $73.64 / $73.64	Facility	26	$73.64	$73.64	$73.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $270.64 / $549.01 / $1,122.97	Professional		$270.64	$549.01	$1,122.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.68 / $106.09 / $188.60	Professional	26	$61.68	$106.09	$188.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $185.43 / $413.34 / $982.15	Professional	TC	$185.43	$413.34	$982.15
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $97.46 / $144.00 / $264.00	Facility	26	$97.46	$144.00	$264.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $87.00 / $210.00 / $450.00	Professional		$87.00	$210.00	$450.00
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $97.46 / $97.46 / $239.35	Professional	26	$97.46	$97.46	$239.35
Medcost Facility/Professional Professional Modifier 50 Low / Median / High Price $873.68 / $873.68 / $1,140.38	Professional	50	$873.68	$873.68	$1,140.38
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $65.69 / $193.03 / $344.56	Professional		$65.69	$193.03	$344.56
United Facility/Professional Professional Modifier Low / Median / High Price $221.83 / $437.81 / $671.70	Professional		$221.83	$437.81	$671.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.80 / $95.83 / $184.99	Professional	26	$64.80	$95.83	$184.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $151.58 / $315.41 / $554.37	Professional	TC	$151.58	$315.41	$554.37
Wellcare Facility/Professional Facility Modifier 26 Low / Median / High Price $466.08 / $586.88 / $586.88	Facility	26	$466.08	$586.88	$586.88
Wellcare Facility/Professional Professional Modifier Low / Median / High Price $2,873.43 / $2,873.43 / $2,873.43	Professional		$2,873.43	$2,873.43	$2,873.43
Wellcare Facility/Professional Professional Modifier 26 Low / Median / High Price $542.85 / $542.85 / $542.85	Professional	26	$542.85	$542.85	$542.85
Wellcare Facility/Professional Professional Modifier TC Low / Median / High Price $2,524.69 / $2,524.69 / $2,524.69	Professional	TC	$2,524.69	$2,524.69	$2,524.69