Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $109.65 / $154.88 / $263.03	Facility	26	$109.65	$154.88	$263.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $691.83 / $1,023.29 / $3,311.31	Professional		$691.83	$1,023.29	$3,311.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $190.55 / $691.83	Professional	26	$107.15	$190.55	$691.83
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $630.96 / $891.25 / $1,071.52	Professional	52	$630.96	$891.25	$1,071.52
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $398.11 / $426.58 / $676.08	Professional	53	$398.11	$426.58	$676.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $575.44 / $758.58 / $1,548.82	Professional	TC	$575.44	$758.58	$1,548.82
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $1,122.02 / $1,380.38	Professional		$512.86	$1,122.02	$1,380.38
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $141.25 / $302.00	Professional	26	$114.82	$141.25	$302.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $831.76 / $977.24 / $1,479.11	Professional		$831.76	$977.24	$1,479.11
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $204.17 / $281.84	Professional	26	$134.90	$204.17	$281.84
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $660.69 / $776.25 / $1,174.90	Professional	TC	$660.69	$776.25	$1,174.90
BCBS Facility/Professional Professional Modifier Low / Median / High Price $776.25 / $977.24 / $1,288.25	Professional		$776.25	$977.24	$1,288.25
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $151.36 / $251.19	Professional	26	$120.23	$151.36	$251.19
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $660.69 / $831.76 / $1,096.48	Professional	TC	$660.69	$831.76	$1,096.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $724.44 / $1,148.15 / $2,137.96	Professional		$724.44	$1,148.15	$2,137.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $208.93 / $363.08	Professional	26	$117.49	$208.93	$363.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $616.60 / $933.25 / $1,778.28	Professional	TC	$616.60	$933.25	$1,778.28
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $257.04 / $794.33 / $794.33	Facility	26	$257.04	$794.33	$794.33
Medica Facility/Professional Facility Modifier 53 Low / Median / High Price $281.84 / $645.65 / $645.65	Facility	53	$281.84	$645.65	$645.65
Medica Facility/Professional Professional Modifier Low / Median / High Price $831.76 / $1,230.27 / $5,370.32	Professional		$831.76	$1,230.27	$5,370.32
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $218.78 / $1,047.13	Professional	26	$131.83	$218.78	$1,047.13
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $691.83 / $1,023.29 / $4,466.84	Professional	TC	$691.83	$1,023.29	$4,466.84
Qualchoice Facility/Professional Professional Modifier Low / Median / High Price $912.01 / $912.01 / $1,096.48	Professional		$912.01	$912.01	$1,096.48
United Facility/Professional Professional Modifier Low / Median / High Price $776.25 / $977.24 / $1,621.81	Professional		$776.25	$977.24	$1,621.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $162.18 / $281.84	Professional	26	$120.23	$162.18	$281.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $645.65 / $812.83 / $1,380.38	Professional	TC	$645.65	$812.83	$1,380.38