Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.89 / $89.51 / $138.93	Facility	26	$54.89	$89.51	$138.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $246.93 / $316.29 / $763.42	Professional		$246.93	$316.29	$763.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.46 / $88.85 / $327.04	Professional	26	$51.46	$88.85	$327.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.34 / $206.18 / $441.79	Professional	TC	$162.34	$206.18	$441.79
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $192.60 / $354.02 / $644.30	Professional		$192.60	$354.02	$644.30
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.47 / $72.47 / $113.90	Professional	26	$40.47	$72.47	$113.90
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $148.06 / $151.36 / $283.79	Professional	TC	$148.06	$151.36	$283.79
BCBS Facility/Professional Professional Modifier Low / Median / High Price $227.65 / $227.65 / $227.65	Professional		$227.65	$227.65	$227.65
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $112.79 / $181.89 / $223.16	Professional	26	$112.79	$181.89	$223.16
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $220.75 / $300.32 / $601.09	Professional	TC	$220.75	$300.32	$601.09
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.58 / $62.58 / $62.58	Facility	26	$62.58	$62.58	$62.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $289.68 / $463.15 / $687.22	Professional		$289.68	$463.15	$687.22
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.89 / $108.18 / $166.12	Professional	26	$60.89	$108.18	$166.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $225.98 / $354.54 / $542.36	Professional	TC	$225.98	$354.54	$542.36
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $88.59 / $150.00 / $156.00	Facility	26	$88.59	$150.00	$156.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $73.00 / $280.00 / $954.30	Professional		$73.00	$280.00	$954.30
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $95.71 / $95.71 / $150.00	Professional	26	$95.71	$95.71	$150.00
Medcost Facility/Professional Professional Modifier TC Low / Median / High Price $752.27 / $752.27 / $752.27	Professional	TC	$752.27	$752.27	$752.27
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $73.78 / $279.70 / $451.88	Professional		$73.78	$279.70	$451.88
United Facility/Professional Professional Modifier Low / Median / High Price $264.98 / $403.42 / $707.48	Professional		$264.98	$403.42	$707.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $57.08 / $90.89 / $171.44	Professional	26	$57.08	$90.89	$171.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $209.20 / $312.27 / $555.95	Professional	TC	$209.20	$312.27	$555.95
Wellcare Facility/Professional Facility Modifier 26 Low / Median / High Price $171.00 / $377.88 / $377.88	Facility	26	$171.00	$377.88	$377.88
Wellcare Facility/Professional Professional Modifier Low / Median / High Price $2,195.03 / $2,195.03 / $2,426.79	Professional		$2,195.03	$2,195.03	$2,426.79
Wellcare Facility/Professional Professional Modifier 26 Low / Median / High Price $480.20 / $480.20 / $521.02	Professional	26	$480.20	$480.20	$521.02
Wellcare Facility/Professional Professional Modifier TC Low / Median / High Price $1,755.75 / $1,755.75 / $1,905.76	Professional	TC	$1,755.75	$1,755.75	$1,905.76