Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $120.23 / $263.03	Facility	26	$100.00	$120.23	$263.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $741.31 / $1,513.56	Professional		$524.81	$741.31	$1,513.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $194.98 / $537.03	Professional	26	$109.65	$194.98	$537.03
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $173.78 / $281.84 / $912.01	Professional	52	$173.78	$281.84	$912.01
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $398.11 / $588.84 / $1,258.93	Professional	TC	$398.11	$588.84	$1,258.93
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $602.56 / $1,023.29	Professional		$489.78	$602.56	$1,023.29
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $141.25 / $208.93	Professional	26	$104.71	$141.25	$208.93
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $501.19 / $588.84	Professional	TC	$234.42	$501.19	$588.84
BCBS Facility/Professional Professional Modifier Low / Median / High Price $851.14 / $851.14 / $870.96	Professional		$851.14	$851.14	$870.96
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $162.18 / $380.19	Professional	26	$109.65	$162.18	$380.19
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $457.09 / $562.34 / $1,513.56	Professional	TC	$457.09	$562.34	$1,513.56
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.18 / $131.83 / $190.55	Facility	26	$28.18	$131.83	$190.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $1,023.29 / $1,698.24	Professional		$630.96	$1,023.29	$1,698.24
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $213.80 / $363.08	Professional	26	$120.23	$213.80	$363.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $501.19 / $812.83 / $1,380.38	Professional	TC	$501.19	$812.83	$1,380.38
Medcost Facility/Professional Professional Modifier Low / Median / High Price $1,071.52 / $1,071.52 / $1,071.52	Professional		$1,071.52	$1,071.52	$1,071.52
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $269.15 / $269.15 / $269.15	Professional	26	$269.15	$269.15	$269.15
Medcost Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $478.63 / $478.63	Professional		$478.63	$478.63	$478.63
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $776.25 / $1,202.26	Professional		$169.82	$776.25	$1,202.26
United Facility/Professional Professional Modifier Low / Median / High Price $562.34 / $776.25 / $1,258.93	Professional		$562.34	$776.25	$1,258.93
United Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $162.18 / $269.15	Professional	26	$112.20	$162.18	$269.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $446.68 / $616.60 / $1,023.29	Professional	TC	$446.68	$616.60	$1,023.29
Wellcare Facility/Professional Facility Modifier 26 Low / Median / High Price $741.31 / $741.31 / $741.31	Facility	26	$741.31	$741.31	$741.31
Wellcare Facility/Professional Professional Modifier Low / Median / High Price $6,165.95 / $6,165.95 / $6,165.95	Professional		$6,165.95	$6,165.95	$6,165.95
Wellcare Facility/Professional Professional Modifier 26 Low / Median / High Price $2,570.40 / $2,570.40 / $2,570.40	Professional	26	$2,570.40	$2,570.40	$2,570.40
Wellcare Facility/Professional Professional Modifier TC Low / Median / High Price $7,079.46 / $7,079.46 / $7,079.46	Professional	TC	$7,079.46	$7,079.46	$7,079.46