Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $5,102.10 / $9,430.04 / $12,626.04	Facility		$5,102.10	$9,430.04	$12,626.04
Aetna Facility/Professional Facility Modifier 22 Low / Median / High Price $6,707.22 / $6,707.22 / $6,707.22	Facility	22	$6,707.22	$6,707.22	$6,707.22
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $325.42 / $346.68 / $515.36	Facility	52	$325.42	$346.68	$515.36
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $130.16 / $138.66 / $206.14	Facility	53	$130.16	$138.66	$206.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $611.12 / $767.50 / $1,947.85	Professional		$611.12	$767.50	$1,947.85
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $603.79 / $990.23 / $1,207.59	Professional		$603.79	$990.23	$1,207.59
BCBS Facility/Professional Professional Modifier Low / Median / High Price $815.13 / $1,198.89 / $1,901.47	Professional		$815.13	$1,198.89	$1,901.47
Cigna Facility/Professional Facility Modifier Low / Median / High Price $606.10 / $3,328.21 / $11,676.00	Facility		$606.10	$3,328.21	$11,676.00
Cigna Facility/Professional Facility Modifier 52 Low / Median / High Price $594.13 / $594.13 / $594.13	Facility	52	$594.13	$594.13	$594.13
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $148.53 / $148.53 / $148.53	Facility	53	$148.53	$148.53	$148.53
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $74.27 / $74.27 / $74.27	Facility	AS	$74.27	$74.27	$74.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $729.12 / $1,008.93 / $1,693.66	Professional		$729.12	$1,008.93	$1,693.66
Medcost Facility/Professional Facility Modifier Low / Median / High Price $650.83 / $912.11 / $1,334.00	Facility		$650.83	$912.11	$1,334.00
Medcost Facility/Professional Facility Modifier 80 Low / Median / High Price $176.97 / $240.00 / $266.80	Facility	80	$176.97	$240.00	$266.80
Medcost Facility/Professional Facility Modifier AS Low / Median / High Price $105.05 / $161.97 / $182.92	Facility	AS	$105.05	$161.97	$182.92
Medcost Facility/Professional Professional Modifier Low / Median / High Price $800.00 / $908.00 / $3,065.43	Professional		$800.00	$908.00	$3,065.43
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $831.10 / $992.89 / $1,269.20	Professional		$831.10	$992.89	$1,269.20
United Facility/Professional Facility Modifier Low / Median / High Price $1,717.00 / $2,500.00 / $18,665.00	Facility		$1,717.00	$2,500.00	$18,665.00
United Facility/Professional Professional Modifier Low / Median / High Price $605.50 / $799.84 / $1,611.95	Professional		$605.50	$799.84	$1,611.95
Wellcare Facility/Professional Facility Modifier Low / Median / High Price $4,956.00 / $16,223.75 / $16,223.75	Facility		$4,956.00	$16,223.75	$16,223.75
Wellcare Facility/Professional Facility Modifier 52 Low / Median / High Price $1,169.61 / $12,302.24 / $12,302.24	Facility	52	$1,169.61	$12,302.24	$12,302.24
Wellcare Facility/Professional Facility Modifier 53 Low / Median / High Price $292.39 / $3,075.56 / $3,075.56	Facility	53	$292.39	$3,075.56	$3,075.56
Wellcare Facility/Professional Facility Modifier AS Low / Median / High Price $146.19 / $1,537.78 / $1,537.78	Facility	AS	$146.19	$1,537.78	$1,537.78
Wellcare Facility/Professional Professional Modifier Low / Median / High Price $4,971.47 / $4,971.47 / $5,729.25	Professional		$4,971.47	$4,971.47	$5,729.25