Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $77.87 / $115.00 / $283.33	Facility	26	$77.87	$115.00	$283.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $323.80 / $425.00 / $1,320.50	Professional		$323.80	$425.00	$1,320.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.88 / $126.00 / $252.28	Professional	26	$77.88	$126.00	$252.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $245.92 / $335.00 / $672.30	Professional	TC	$245.92	$335.00	$672.30
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $233.75 / $308.98 / $308.98	Professional		$233.75	$308.98	$308.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $57.02 / $71.97 / $143.76	Professional	26	$57.02	$71.97	$143.76
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $165.74 / $165.74 / $165.74	Professional	TC	$165.74	$165.74	$165.74
BCBS Facility/Professional Professional Modifier Low / Median / High Price $200.73 / $200.73 / $200.73	Professional		$200.73	$200.73	$200.73
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $124.45 / $179.40 / $234.06	Professional	26	$124.45	$179.40	$234.06
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $598.59 / $770.26 / $1,037.55	Professional	TC	$598.59	$770.26	$1,037.55
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $88.30 / $88.30 / $88.30	Facility	26	$88.30	$88.30	$88.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $415.99 / $725.59 / $1,301.22	Professional		$415.99	$725.59	$1,301.22
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.41 / $126.64 / $222.44	Professional	26	$74.41	$126.64	$222.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $317.51 / $583.29 / $1,109.91	Professional	TC	$317.51	$583.29	$1,109.91
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $117.02 / $133.00 / $245.01	Facility	26	$117.02	$133.00	$245.01
Medcost Facility/Professional Professional Modifier Low / Median / High Price $103.00 / $369.00 / $550.00	Professional		$103.00	$369.00	$550.00
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $117.02 / $117.02 / $133.00	Professional	26	$117.02	$117.02	$133.00
Medcost Facility/Professional Professional Modifier TC Low / Median / High Price $904.99 / $904.99 / $904.99	Professional	TC	$904.99	$904.99	$904.99
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $78.12 / $309.77 / $515.22	Professional		$78.12	$309.77	$515.22
United Facility/Professional Professional Modifier Low / Median / High Price $349.12 / $575.70 / $992.29	Professional		$349.12	$575.70	$992.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $78.18 / $107.05 / $223.85	Professional	26	$78.18	$107.05	$223.85
United Facility/Professional Professional Modifier TC Low / Median / High Price $267.82 / $488.54 / $803.50	Professional	TC	$267.82	$488.54	$803.50
Wellcare Facility/Professional Facility Modifier 26 Low / Median / High Price $558.79 / $703.76 / $703.76	Facility	26	$558.79	$703.76	$703.76
Wellcare Facility/Professional Professional Modifier Low / Median / High Price $3,448.60 / $3,448.60 / $3,448.60	Professional		$3,448.60	$3,448.60	$3,448.60
Wellcare Facility/Professional Professional Modifier 26 Low / Median / High Price $586.14 / $586.14 / $616.42	Professional	26	$586.14	$586.14	$616.42
Wellcare Facility/Professional Professional Modifier TC Low / Median / High Price $3,030.13 / $3,030.13 / $3,030.13	Professional	TC	$3,030.13	$3,030.13	$3,030.13