Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $106.87 / $106.87 / $106.87	Facility	26	$106.87	$106.87	$106.87
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $139.15 / $139.15 / $139.15	Facility	53	$139.15	$139.15	$139.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $695.73 / $1,908.33 / $4,569.96	Professional		$695.73	$1,908.33	$4,569.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $106.87 / $424.30 / $663.14	Professional	26	$106.87	$424.30	$663.14
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $347.87 / $624.26 / $1,014.02	Professional	52	$347.87	$624.26	$1,014.02
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $139.15 / $139.15 / $938.49	Professional	53	$139.15	$139.15	$938.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $588.86 / $716.88 / $1,976.52	Professional	TC	$588.86	$716.88	$1,976.52
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $212.61 / $212.61 / $212.61	Professional	26	$212.61	$212.61	$212.61
BCBS Facility/Professional Professional Modifier Low / Median / High Price $654.47 / $1,104.42 / $1,487.44	Professional		$654.47	$1,104.42	$1,487.44
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $102.58 / $173.09 / $233.13	Professional	26	$102.58	$173.09	$233.13
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $551.88 / $931.29 / $1,254.29	Professional	TC	$551.88	$931.29	$1,254.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $982.56 / $1,620.04 / $2,105.34	Professional		$982.56	$1,620.04	$2,105.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $178.10 / $250.01 / $335.38	Professional	26	$178.10	$250.01	$335.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $782.71 / $1,370.03 / $1,780.43	Professional	TC	$782.71	$1,370.03	$1,780.43
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $789.30 / $789.30 / $789.30	Facility	26	$789.30	$789.30	$789.30
Medica Facility/Professional Facility Modifier 53 Low / Median / High Price $643.30 / $643.30 / $643.30	Facility	53	$643.30	$643.30	$643.30
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,288.58 / $1,687.84 / $5,332.25	Professional		$1,288.58	$1,687.84	$5,332.25
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $204.74 / $280.43 / $1,044.83	Professional	26	$204.74	$280.43	$1,044.83
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $1,030.76 / $1,358.36 / $4,416.72	Professional	TC	$1,030.76	$1,358.36	$4,416.72
Midlands Facility/Professional Professional Modifier Low / Median / High Price $1,231.49 / $1,680.21 / $2,185.59	Professional		$1,231.49	$1,680.21	$2,185.59
United Facility/Professional Professional Modifier Low / Median / High Price $1,288.58 / $1,570.47 / $1,975.57	Professional		$1,288.58	$1,570.47	$1,975.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $201.90 / $268.24 / $345.66	Professional	26	$201.90	$268.24	$345.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $1,030.76 / $1,358.36 / $1,604.22	Professional	TC	$1,030.76	$1,358.36	$1,604.22