Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $111.90 / $111.90 / $236.03	Facility	26	$111.90	$111.90	$236.03
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $150.83 / $150.83 / $180.15	Facility	53	$150.83	$150.83	$180.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $754.15 / $1,008.78 / $2,653.78	Professional		$754.15	$1,008.78	$2,653.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $111.90 / $187.33 / $550.84	Professional	26	$111.90	$187.33	$550.84
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $351.90 / $377.08 / $605.58	Professional	52	$351.90	$377.08	$605.58
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $150.83 / $150.83 / $242.23	Professional	53	$150.83	$150.83	$242.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $642.25 / $710.50 / $1,160.76	Professional	TC	$642.25	$710.50	$1,160.76
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $1,433.07 / $1,433.07 / $1,433.07	Professional		$1,433.07	$1,433.07	$1,433.07
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $163.49 / $163.49 / $223.71	Professional	26	$163.49	$163.49	$223.71
BCBS Facility/Professional Professional Modifier Low / Median / High Price $453.90 / $453.90 / $453.90	Professional		$453.90	$453.90	$453.90
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $226.94 / $388.75 / $503.65	Professional	26	$226.94	$388.75	$503.65
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $948.22 / $1,408.75 / $2,010.61	Professional	TC	$948.22	$1,408.75	$2,010.61
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $126.71 / $126.71 / $126.71	Facility	26	$126.71	$126.71	$126.71
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $163.30 / $163.30 / $163.30	Facility	53	$163.30	$163.30	$163.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $847.80 / $1,289.59 / $2,199.02	Professional		$847.80	$1,289.59	$2,199.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $133.29 / $253.77 / $450.53	Professional	26	$133.29	$253.77	$450.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $684.20 / $1,042.79 / $1,805.75	Professional	TC	$684.20	$1,042.79	$1,805.75
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $170.07 / $262.97 / $524.29	Facility	26	$170.07	$262.97	$524.29
Medcost Facility/Professional Professional Modifier Low / Median / High Price $194.00 / $963.00 / $1,157.00	Professional		$194.00	$963.00	$1,157.00
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $203.79 / $411.79 / $475.00	Professional	26	$203.79	$411.79	$475.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $871.80 / $1,198.70 / $2,083.69	Professional		$871.80	$1,198.70	$2,083.69
United Facility/Professional Professional Modifier Low / Median / High Price $823.60 / $1,130.40 / $2,056.23	Professional		$823.60	$1,130.40	$2,056.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $128.57 / $202.53 / $360.45	Professional	26	$128.57	$202.53	$360.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $653.87 / $927.26 / $1,679.50	Professional	TC	$653.87	$927.26	$1,679.50
Wellcare Facility/Professional Facility Modifier 26 Low / Median / High Price $259.19 / $789.30 / $789.30	Facility	26	$259.19	$789.30	$789.30
Wellcare Facility/Professional Facility Modifier 53 Low / Median / High Price $271.97 / $754.92 / $754.92	Facility	53	$271.97	$754.92	$754.92
Wellcare Facility/Professional Professional Modifier Low / Median / High Price $5,492.22 / $5,492.22 / $5,862.60	Professional		$5,492.22	$5,492.22	$5,862.60
Wellcare Facility/Professional Professional Modifier 26 Low / Median / High Price $942.99 / $942.99 / $1,044.83	Professional	26	$942.99	$942.99	$1,044.83
Wellcare Facility/Professional Professional Modifier TC Low / Median / High Price $4,549.22 / $4,549.22 / $4,976.85	Professional	TC	$4,549.22	$4,549.22	$4,976.85