Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.82 / $45.27 / $74.65	Facility	26	$42.82	$45.27	$74.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $139.33 / $165.59 / $697.60	Professional		$139.33	$165.59	$697.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.81 / $46.20 / $132.41	Professional	26	$41.81	$46.20	$132.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $96.50 / $111.43 / $241.48	Professional	TC	$96.50	$111.43	$241.48
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $114.67 / $144.16 / $395.00	Professional		$114.67	$144.16	$395.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.19 / $56.09 / $98.98	Professional	26	$35.19	$56.09	$98.98
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $80.14 / $142.21 / $152.86	Professional	TC	$80.14	$142.21	$152.86
BCBS Facility/Professional Professional Modifier Low / Median / High Price $250.00 / $250.00 / $266.23	Professional		$250.00	$250.00	$266.23
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $77.06 / $109.95 / $137.74	Professional	26	$77.06	$109.95	$137.74
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $181.12 / $226.40 / $328.11	Professional	TC	$181.12	$226.40	$328.11
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.02 / $54.02 / $54.02	Facility	26	$54.02	$54.02	$54.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $166.51 / $257.77 / $432.31	Professional		$166.51	$257.77	$432.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.00 / $75.77 / $132.43	Professional	26	$50.00	$75.77	$132.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $115.89 / $180.79 / $305.79	Professional	TC	$115.89	$180.79	$305.79
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $55.44 / $72.23 / $147.12	Facility	26	$55.44	$72.23	$147.12
Medcost Facility/Professional Professional Modifier Low / Median / High Price $61.00 / $204.00 / $569.70	Professional		$61.00	$204.00	$569.70
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $72.23 / $72.23 / $175.09	Professional	26	$72.23	$72.23	$175.09
Medcost Facility/Professional Professional Modifier TC Low / Median / High Price $169.80 / $169.80 / $169.80	Professional	TC	$169.80	$169.80	$169.80
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $49.31 / $147.91 / $259.50	Professional		$49.31	$147.91	$259.50
United Facility/Professional Professional Modifier Low / Median / High Price $160.79 / $251.53 / $428.26	Professional		$160.79	$251.53	$428.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.11 / $72.08 / $126.32	Professional	26	$48.11	$72.08	$126.32
United Facility/Professional Professional Modifier TC Low / Median / High Price $112.04 / $178.69 / $297.27	Professional	TC	$112.04	$178.69	$297.27
Wellcare Facility/Professional Facility Modifier 26 Low / Median / High Price $111.37 / $230.38 / $230.38	Facility	26	$111.37	$230.38	$230.38
Wellcare Facility/Professional Professional Modifier Low / Median / High Price $1,024.30 / $1,326.30 / $1,326.30	Professional		$1,024.30	$1,326.30	$1,326.30
Wellcare Facility/Professional Professional Modifier 26 Low / Median / High Price $300.10 / $376.28 / $376.28	Professional	26	$300.10	$376.28	$376.28
Wellcare Facility/Professional Professional Modifier TC Low / Median / High Price $724.19 / $950.03 / $950.03	Professional	TC	$724.19	$950.03	$950.03