Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.45 / $66.29 / $106.01	Facility	26	$60.45	$66.29	$106.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $90.76 / $106.01 / $253.36	Professional		$90.76	$106.01	$253.36
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $1,503.50 / $1,503.50 / $1,503.50	Professional	25	$1,503.50	$1,503.50	$1,503.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.97 / $62.67 / $130.57	Professional	26	$55.97	$62.67	$130.57
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.38 / $45.56 / $77.38	Professional	TC	$30.38	$45.56	$77.38
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $132.54 / $140.19 / $168.04	Professional		$132.54	$140.19	$168.04
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $108.61 / $108.61 / $108.61	Professional	26	$108.61	$108.61	$108.61
BCBS Facility/Professional Professional Modifier Low / Median / High Price $80.00 / $80.00 / $80.00	Professional		$80.00	$80.00	$80.00
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $55.97 / $103.75 / $201.63	Professional	26	$55.97	$103.75	$201.63
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $40.04 / $56.07 / $72.09	Professional	TC	$40.04	$56.07	$72.09
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $68.20 / $68.20 / $68.20	Facility	26	$68.20	$68.20	$68.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $107.81 / $148.41 / $255.95	Professional		$107.81	$148.41	$255.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.29 / $103.07 / $166.75	Professional	26	$69.29	$103.07	$166.75
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $33.15 / $49.72 / $87.23	Professional	TC	$33.15	$49.72	$87.23
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $71.38 / $82.02 / $134.33	Facility	26	$71.38	$82.02	$134.33
Medcost Facility/Professional Professional Modifier Low / Median / High Price $40.00 / $85.00 / $125.00	Professional		$40.00	$85.00	$125.00
Medcost Facility/Professional Professional Modifier TC Low / Median / High Price $28.89 / $28.89 / $28.89	Professional	TC	$28.89	$28.89	$28.89
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $65.86 / $95.14 / $167.08	Professional		$65.86	$95.14	$167.08
United Facility/Professional Professional Modifier Low / Median / High Price $83.16 / $107.40 / $199.44	Professional		$83.16	$107.40	$199.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $55.22 / $72.12 / $131.82	Professional	26	$55.22	$72.12	$131.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.25 / $35.86 / $69.76	Professional	TC	$25.25	$35.86	$69.76
Wellcare Facility/Professional Facility Modifier 26 Low / Median / High Price $108.78 / $140.60 / $294.26	Facility	26	$108.78	$140.60	$294.26
Wellcare Facility/Professional Professional Modifier Low / Median / High Price $865.60 / $865.60 / $865.60	Professional		$865.60	$865.60	$865.60
Wellcare Facility/Professional Professional Modifier 26 Low / Median / High Price $382.35 / $382.35 / $477.60	Professional	26	$382.35	$382.35	$477.60
Wellcare Facility/Professional Professional Modifier TC Low / Median / High Price $307.58 / $307.58 / $380.25	Professional	TC	$307.58	$307.58	$380.25