Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $158.00 / $387.75 / $519.75	Facility		$158.00	$387.75	$519.75
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.67 / $22.90 / $38.47	Facility	26	$19.67	$22.90	$38.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $113.82 / $131.35 / $356.91	Professional		$113.82	$131.35	$356.91
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.44 / $22.90 / $78.12	Professional	26	$18.44	$22.90	$78.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $99.13 / $106.95 / $219.06	Professional	TC	$99.13	$106.95	$219.06
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $102.32 / $161.62 / $308.98	Professional		$102.32	$161.62	$308.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $16.73 / $23.95 / $47.09	Professional	26	$16.73	$23.95	$47.09
BCBS Facility/Professional Facility Modifier Low / Median / High Price $216.52 / $259.82 / $325.68	Facility		$216.52	$259.82	$325.68
BCBS Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $50.00 / $50.00	Professional		$50.00	$50.00	$50.00
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $28.10 / $45.42 / $65.59	Professional	26	$28.10	$45.42	$65.59
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $137.61 / $186.75 / $308.38	Professional	TC	$137.61	$186.75	$308.38
Cigna Facility/Professional Facility Modifier Low / Median / High Price $120.07 / $174.75 / $320.80	Facility		$120.07	$174.75	$320.80
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.35 / $26.35 / $26.35	Facility	26	$26.35	$26.35	$26.35
Cigna Facility/Professional Professional Modifier Low / Median / High Price $150.29 / $229.92 / $372.91	Professional		$150.29	$229.92	$372.91
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.53 / $31.87 / $53.56	Professional	26	$21.53	$31.87	$53.56
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $124.98 / $202.69 / $310.06	Professional	TC	$124.98	$202.69	$310.06
Medcost Facility/Professional Facility Modifier Low / Median / High Price $119.85 / $193.07 / $306.56	Facility		$119.85	$193.07	$306.56
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $20.82 / $33.00 / $50.23	Facility	26	$20.82	$33.00	$50.23
Medcost Facility/Professional Professional Modifier Low / Median / High Price $31.00 / $159.00 / $464.53	Professional		$31.00	$159.00	$464.53
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $20.82 / $20.82 / $33.00	Professional	26	$20.82	$20.82	$33.00
Medcost Facility/Professional Professional Modifier 50 Low / Median / High Price $179.78 / $345.00 / $696.79	Professional	50	$179.78	$345.00	$696.79
Medcost Facility/Professional Professional Modifier TC Low / Median / High Price $380.25 / $380.25 / $380.25	Professional	TC	$380.25	$380.25	$380.25
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $34.42 / $185.87 / $277.50	Professional		$34.42	$185.87	$277.50
United Facility/Professional Professional Modifier Low / Median / High Price $143.13 / $208.33 / $378.87	Professional		$143.13	$208.33	$378.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $18.55 / $27.57 / $61.69	Professional	26	$18.55	$27.57	$61.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $119.02 / $178.49 / $287.60	Professional	TC	$119.02	$178.49	$287.60
Wellcare Facility/Professional Facility Modifier Low / Median / High Price $264.44 / $709.37 / $709.37	Facility		$264.44	$709.37	$709.37
Wellcare Facility/Professional Facility Modifier 26 Low / Median / High Price $52.93 / $161.00 / $161.00	Facility	26	$52.93	$161.00	$161.00
Wellcare Facility/Professional Professional Modifier Low / Median / High Price $1,116.23 / $1,116.23 / $1,256.91	Professional		$1,116.23	$1,116.23	$1,256.91
Wellcare Facility/Professional Professional Modifier 26 Low / Median / High Price $237.75 / $237.75 / $237.75	Professional	26	$237.75	$237.75	$237.75
Wellcare Facility/Professional Professional Modifier TC Low / Median / High Price $934.20 / $934.20 / $1,145.18	Professional	TC	$934.20	$934.20	$1,145.18