Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $83.59 / $102.70 / $155.59	Facility	26	$83.59	$102.70	$155.59
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $43.98 / $55.26 / $155.85	Facility	53	$43.98	$55.26	$155.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $218.80 / $359.33 / $1,471.88	Professional		$218.80	$359.33	$1,471.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.73 / $115.00 / $341.32	Professional	26	$66.73	$115.00	$341.32
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $120.59 / $161.94 / $237.50	Professional	52	$120.59	$161.94	$237.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $177.84 / $244.98 / $869.24	Professional	TC	$177.84	$244.98	$869.24
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $112.92 / $148.79 / $172.59	Professional		$112.92	$148.79	$172.59
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $51.70 / $72.77 / $110.36	Professional	26	$51.70	$72.77	$110.36
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $108.44 / $108.44 / $230.00	Professional	TC	$108.44	$108.44	$230.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $206.16 / $270.60 / $829.74	Professional		$206.16	$270.60	$829.74
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $73.31 / $94.33 / $153.66	Professional	26	$73.31	$94.33	$153.66
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $132.85 / $176.44 / $676.06	Professional	TC	$132.85	$176.44	$676.06
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.26 / $80.26 / $80.26	Facility	26	$80.26	$80.26	$80.26
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $45.11 / $45.11 / $45.11	Facility	53	$45.11	$45.11	$45.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $171.25 / $353.61 / $848.21	Professional		$171.25	$353.61	$848.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.10 / $100.94 / $176.53	Professional	26	$61.10	$100.94	$176.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $113.59 / $237.99 / $732.29	Professional	TC	$113.59	$237.99	$732.29
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $507.76 / $656.72 / $656.72	Facility	26	$507.76	$656.72	$656.72
Medica Facility/Professional Facility Modifier 53 Low / Median / High Price $117.72 / $285.58 / $285.58	Facility	53	$117.72	$285.58	$285.58
Medica Facility/Professional Professional Modifier Low / Median / High Price $221.93 / $511.40 / $2,872.81	Professional		$221.93	$511.40	$2,872.81
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $72.50 / $102.49 / $584.49	Professional	26	$72.50	$102.49	$584.49
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $145.97 / $406.11 / $2,498.98	Professional	TC	$145.97	$406.11	$2,498.98
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $126.91 / $126.91 / $126.91	Professional	26	$126.91	$126.91	$126.91
United Facility/Professional Professional Modifier Low / Median / High Price $201.53 / $317.30 / $771.82	Professional		$201.53	$317.30	$771.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.86 / $88.76 / $164.58	Professional	26	$69.86	$88.76	$164.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $135.44 / $203.16 / $540.99	Professional	TC	$135.44	$203.16	$540.99