Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $103.76 / $145.26 / $296.52	Facility	26	$103.76	$145.26	$296.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $516.92 / $777.87 / $1,393.25	Professional		$516.92	$777.87	$1,393.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $103.76 / $134.63 / $518.72	Professional	26	$103.76	$134.63	$518.72
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $258.47 / $297.79 / $480.85	Professional	52	$258.47	$297.79	$480.85
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $413.17 / $607.95 / $1,030.18	Professional	TC	$413.17	$607.95	$1,030.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $552.51 / $1,039.68 / $1,059.29	Professional		$552.51	$1,039.68	$1,059.29
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $159.58 / $199.17 / $219.52	Professional	26	$159.58	$199.17	$219.52
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $621.47 / $621.47 / $621.47	Professional	TC	$621.47	$621.47	$621.47
BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,568.72 / $1,568.72 / $1,568.74	Professional		$1,568.72	$1,568.72	$1,568.74
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $113.81 / $218.11 / $416.53	Professional	26	$113.81	$218.11	$416.53
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $480.29 / $672.41 / $1,693.67	Professional	TC	$480.29	$672.41	$1,693.67
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $139.38 / $139.38 / $139.38	Facility	26	$139.38	$139.38	$139.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $663.73 / $1,105.47 / $1,814.12	Professional		$663.73	$1,105.47	$1,814.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $136.94 / $223.69 / $363.30	Professional	26	$136.94	$223.69	$363.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $526.79 / $868.30 / $1,434.78	Professional	TC	$526.79	$868.30	$1,434.78
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $144.49 / $238.00 / $278.89	Facility	26	$144.49	$238.00	$278.89
Medcost Facility/Professional Professional Modifier Low / Median / High Price $160.00 / $657.00 / $817.00	Professional		$160.00	$657.00	$817.00
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $190.11 / $190.11 / $190.11	Professional	26	$190.11	$190.11	$190.11
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $187.15 / $814.56 / $1,090.69	Professional		$187.15	$814.56	$1,090.69
United Facility/Professional Professional Modifier Low / Median / High Price $608.79 / $840.13 / $1,550.71	Professional		$608.79	$840.13	$1,550.71
United Facility/Professional Professional Modifier 26 Low / Median / High Price $122.97 / $182.32 / $322.58	Professional	26	$122.97	$182.32	$322.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $482.63 / $655.08 / $1,231.53	Professional	TC	$482.63	$655.08	$1,231.53
Wellcare Facility/Professional Facility Modifier 26 Low / Median / High Price $288.64 / $753.90 / $753.90	Facility	26	$288.64	$753.90	$753.90
Wellcare Facility/Professional Professional Modifier Low / Median / High Price $6,200.00 / $6,200.00 / $6,200.00	Professional		$6,200.00	$6,200.00	$6,200.00
Wellcare Facility/Professional Professional Modifier 26 Low / Median / High Price $1,081.48 / $1,081.48 / $1,081.48	Professional	26	$1,081.48	$1,081.48	$1,081.48
Wellcare Facility/Professional Professional Modifier TC Low / Median / High Price $3,991.74 / $3,991.74 / $4,567.58	Professional	TC	$3,991.74	$3,991.74	$4,567.58