Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $141.25 / $316.23	Facility	26	$104.71	$141.25	$316.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $549.54 / $794.33 / $1,584.89	Professional		$549.54	$794.33	$1,584.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $194.98 / $549.54	Professional	26	$114.82	$194.98	$549.54
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $190.55 / $275.42 / $954.99	Professional	52	$190.55	$275.42	$954.99
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $416.87 / $616.60 / $1,148.15	Professional	TC	$416.87	$616.60	$1,148.15
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $616.60 / $1,047.13	Professional		$537.03	$616.60	$1,047.13
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $141.25 / $213.80	Professional	26	$109.65	$141.25	$213.80
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $288.40 / $288.40 / $288.40	Professional	52	$288.40	$288.40	$288.40
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $457.09 / $478.63 / $616.60	Professional	TC	$457.09	$478.63	$616.60
BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,584.89 / $1,584.89 / $1,584.89	Professional		$1,584.89	$1,584.89	$1,584.89
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $169.82 / $389.05	Professional	26	$114.82	$169.82	$389.05
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $478.63 / $602.56 / $1,584.89	Professional	TC	$478.63	$602.56	$1,584.89
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.51 / $138.04 / $199.53	Facility	26	$29.51	$138.04	$199.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $660.69 / $1,122.02 / $1,862.09	Professional		$660.69	$1,122.02	$1,862.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $229.09 / $380.19	Professional	26	$128.82	$229.09	$380.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $524.81 / $891.25 / $1,479.11	Professional	TC	$524.81	$891.25	$1,479.11
Medcost Facility/Professional Professional Modifier Low / Median / High Price $1,174.90 / $1,174.90 / $1,174.90	Professional		$1,174.90	$1,174.90	$1,174.90
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $288.40 / $288.40 / $288.40	Professional	26	$288.40	$288.40	$288.40
Medcost Facility/Professional Professional Modifier Low / Median / High Price $676.08 / $676.08 / $676.08	Professional		$676.08	$676.08	$676.08
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $812.83 / $1,258.93	Professional		$177.83	$812.83	$1,258.93
United Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $812.83 / $1,348.96	Professional		$588.84	$812.83	$1,348.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $169.82 / $288.40	Professional	26	$117.49	$169.82	$288.40
United Facility/Professional Professional Modifier TC Low / Median / High Price $467.74 / $660.69 / $1,071.52	Professional	TC	$467.74	$660.69	$1,071.52
Wellcare Facility/Professional Facility Modifier 26 Low / Median / High Price $776.25 / $776.25 / $776.25	Facility	26	$776.25	$776.25	$776.25
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 $1,071.52 / $1,071.52 / $1,071.52	Professional	26	$1,071.52	$1,071.52	$1,071.52
Wellcare Facility/Professional Professional Modifier TC Low / Median / High Price $3,981.07 / $3,981.07 / $4,570.88	Professional	TC	$3,981.07	$3,981.07	$4,570.88