Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $164.91 / $203.87 / $265.97	Facility	26	$164.91	$203.87	$265.97
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $202.46 / $222.56 / $257.12	Facility	53	$202.46	$222.56	$257.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $794.64 / $1,012.28 / $1,818.54	Professional		$794.64	$1,012.28	$1,818.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $122.48 / $187.33 / $550.84	Professional	26	$122.48	$187.33	$550.84
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $345.55 / $506.14 / $664.50	Professional	52	$345.55	$506.14	$664.50
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $138.22 / $202.46 / $265.80	Professional	53	$138.22	$202.46	$265.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $679.19 / $847.37 / $1,165.53	Professional	TC	$679.19	$847.37	$1,165.53
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $300.19 / $300.19 / $300.19	Professional	26	$300.19	$300.19	$300.19
Ambetter Facility/Professional Professional Modifier 53 Low / Median / High Price $797.16 / $797.16 / $797.16	Professional	53	$797.16	$797.16	$797.16
BCBS Facility/Professional Professional Modifier Low / Median / High Price $892.25 / $1,180.92 / $1,312.13	Professional		$892.25	$1,180.92	$1,312.13
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $141.32 / $187.05 / $207.83	Professional	26	$141.32	$187.05	$207.83
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $750.92 / $993.87 / $1,104.30	Professional	TC	$750.92	$993.87	$1,104.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $820.63 / $1,181.27 / $1,447.32	Professional		$820.63	$1,181.27	$1,447.32
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $136.72 / $216.07 / $277.55	Professional	26	$136.72	$216.07	$277.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $644.05 / $931.98 / $1,218.07	Professional	TC	$644.05	$931.98	$1,218.07
Qualchoice Facility/Professional Professional Modifier 26 Low / Median / High Price $345.22 / $345.22 / $345.22	Professional	26	$345.22	$345.22	$345.22
Qualchoice Facility/Professional Professional Modifier 53 Low / Median / High Price $916.73 / $916.73 / $916.73	Professional	53	$916.73	$916.73	$916.73
United Facility/Professional Professional Modifier Low / Median / High Price $770.39 / $971.29 / $1,633.44	Professional		$770.39	$971.29	$1,633.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $121.86 / $180.14 / $273.82	Professional	26	$121.86	$180.14	$273.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $600.46 / $819.82 / $1,397.64	Professional	TC	$600.46	$819.82	$1,397.64