Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $106.21 / $106.22 / $112.65	Facility	26	$106.21	$106.22	$112.65
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $137.60 / $137.60 / $137.60	Facility	53	$137.60	$137.60	$137.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $671.08 / $804.13 / $1,365.00	Professional		$671.08	$804.13	$1,365.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $105.76 / $113.20 / $207.93	Professional	26	$105.76	$113.20	$207.93
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $335.54 / $361.16 / $463.33	Professional	52	$335.54	$361.16	$463.33
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $134.22 / $144.46 / $190.92	Professional	53	$134.22	$144.46	$190.92
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $564.08 / $653.48 / $836.52	Professional	TC	$564.08	$653.48	$836.52
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $815.97 / $941.51 / $1,004.27	Professional		$815.97	$941.51	$1,004.27
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $109.83 / $154.83 / $154.83	Professional	26	$109.83	$154.83	$154.83
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $738.71 / $896.40 / $1,272.88	Professional		$738.71	$896.40	$1,272.88
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $150.53 / $177.10 / $251.48	Professional	26	$150.53	$177.10	$251.48
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $575.52 / $719.40 / $1,021.54	Professional	TC	$575.52	$719.40	$1,021.54
CareSource Facility/Professional Professional Modifier Low / Median / High Price $108.38 / $573.85 / $795.77	Professional		$108.38	$573.85	$795.77
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $126.71 / $126.71 / $126.71	Facility	26	$126.71	$126.71	$126.71
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $163.30 / $163.30 / $163.30	Facility	53	$163.30	$163.30	$163.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $753.10 / $1,015.18 / $1,779.35	Professional		$753.10	$1,015.18	$1,779.35
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $116.15 / $196.93 / $371.76	Professional	26	$116.15	$196.93	$371.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $628.59 / $813.78 / $1,402.59	Professional	TC	$628.59	$813.78	$1,402.59
United Facility/Professional Professional Modifier Low / Median / High Price $765.17 / $945.42 / $1,613.34	Professional		$765.17	$945.42	$1,613.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $125.49 / $183.77 / $274.68	Professional	26	$125.49	$183.77	$274.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $635.29 / $772.67 / $1,215.94	Professional	TC	$635.29	$772.67	$1,215.94