Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $110.17 / $195.79 / $232.17	Facility	26	$110.17	$195.79	$232.17
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $132.35 / $138.07 / $213.74	Facility	53	$132.35	$138.07	$213.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $671.08 / $954.60 / $4,352.00	Professional		$671.08	$954.60	$4,352.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $106.99 / $173.18 / $649.47	Professional	26	$106.99	$173.18	$649.47
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $335.54 / $345.17 / $514.66	Professional	52	$335.54	$345.17	$514.66
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $134.22 / $138.07 / $205.87	Professional	53	$134.22	$138.07	$205.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $564.08 / $767.25 / $1,165.53	Professional	TC	$564.08	$767.25	$1,165.53
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $512.57 / $782.08 / $782.08	Professional		$512.57	$782.08	$782.08
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $84.57 / $84.57 / $84.57	Professional	26	$84.57	$84.57	$84.57
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $128.13 / $128.13 / $128.13	Professional	52	$128.13	$128.13	$128.13
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $738.71 / $869.08 / $1,373.84	Professional		$738.71	$869.08	$1,373.84
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $145.27 / $201.22 / $287.08	Professional	26	$145.27	$201.22	$287.08
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $561.72 / $660.85 / $1,106.39	Professional	TC	$561.72	$660.85	$1,106.39
CareSource Facility/Professional Professional Modifier Low / Median / High Price $117.73 / $164.16 / $932.04	Professional		$117.73	$164.16	$932.04
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 $788.48 / $1,193.34 / $1,806.73	Professional		$788.48	$1,193.34	$1,806.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $125.07 / $235.30 / $370.08	Professional	26	$125.07	$235.30	$370.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $630.63 / $956.72 / $1,428.08	Professional	TC	$630.63	$956.72	$1,428.08
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $682.66	Professional		$32.34	$32.34	$682.66
United Facility/Professional Professional Modifier Low / Median / High Price $776.73 / $1,001.44 / $1,632.94	Professional		$776.73	$1,001.44	$1,632.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $123.39 / $190.82 / $290.95	Professional	26	$123.39	$190.82	$290.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $620.52 / $844.57 / $1,367.84	Professional	TC	$620.52	$844.57	$1,367.84