Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.86 / $63.10 / $147.91	Facility	26	$47.86	$63.10	$147.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $144.54 / $501.19	Professional		$45.71	$144.54	$501.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $81.28 / $239.88	Professional	26	$43.65	$81.28	$239.88
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $43.65 / $660.69 / $870.96	Professional	50	$43.65	$660.69	$870.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $158.49 / $371.54	Professional	TC	$83.18	$158.49	$371.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $125.89 / $295.12	Professional		$100.00	$125.89	$295.12
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $48.98 / $89.13	Professional	26	$35.48	$48.98	$89.13
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $173.78 / $173.78 / $173.78	Professional	50	$173.78	$173.78	$173.78
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $131.83 / $245.47	Professional	TC	$47.86	$131.83	$245.47
BCBS Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $138.04 / $138.04	Professional		$138.04	$138.04	$138.04
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $123.03 / $144.54	Professional	26	$83.18	$123.03	$144.54
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $354.81 / $501.19	Professional	TC	$208.93	$354.81	$501.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $53.70 / $75.86	Facility	26	$11.48	$53.70	$75.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $309.03 / $512.86	Professional		$154.88	$309.03	$512.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $75.86 / $131.83	Professional	26	$41.69	$75.86	$131.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $218.78 / $380.19	Professional	TC	$104.71	$218.78	$380.19
Medcost Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $389.05 / $389.05	Professional		$389.05	$389.05	$389.05
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $95.50 / $95.50	Professional	26	$95.50	$95.50	$95.50
Medcost Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $223.87 / $223.87	Professional		$223.87	$223.87	$223.87
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $125.89 / $363.08	Professional		$48.98	$125.89	$363.08
United Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $239.88 / $416.87	Professional		$147.91	$239.88	$416.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $63.10 / $117.49	Professional	26	$47.86	$63.10	$117.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $177.83 / $288.40	Professional	TC	$97.72	$177.83	$288.40
Wellcare Facility/Professional Facility Modifier 26 Low / Median / High Price $426.58 / $426.58 / $426.58	Facility	26	$426.58	$426.58	$426.58
Wellcare Facility/Professional Professional Modifier Low / Median / High Price $1,412.54 / $1,412.54 / $1,412.54	Professional		$1,412.54	$1,412.54	$1,412.54
Wellcare Facility/Professional Professional Modifier 26 Low / Median / High Price $302.00 / $302.00 / $380.19	Professional	26	$302.00	$302.00	$380.19
Wellcare Facility/Professional Professional Modifier TC Low / Median / High Price $1,318.26 / $1,318.26 / $1,318.26	Professional	TC	$1,318.26	$1,318.26	$1,318.26