Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $104.71 / $213.80	Facility	26	$104.71	$104.71	$213.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $691.83 / $891.25 / $1,819.70	Professional		$691.83	$891.25	$1,819.70
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $134.90 / $281.84	Professional	26	$107.15	$134.90	$281.84
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $630.96 / $977.24 / $1,000.00	Professional	52	$630.96	$977.24	$1,000.00
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $426.58 / $426.58 / $524.81	Professional	53	$426.58	$426.58	$524.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $575.44 / $707.95 / $954.99	Professional	TC	$575.44	$707.95	$954.99
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $616.60 / $933.25	Professional		$501.19	$616.60	$933.25
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $131.83 / $151.36	Professional	26	$91.20	$131.83	$151.36
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $602.56 / $602.56 / $602.56	Professional	TC	$602.56	$602.56	$602.56
BCBS Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $794.33 / $1,096.48	Professional		$123.03	$794.33	$1,096.48
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $239.88 / $239.88 / $269.15	Facility	26	$239.88	$239.88	$269.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $758.58 / $1,023.29 / $1,380.38	Professional		$758.58	$1,023.29	$1,380.38
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $194.98 / $302.00	Professional	26	$125.89	$194.98	$302.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $575.44 / $812.83 / $1,096.48	Professional	TC	$575.44	$812.83	$1,096.48
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 $645.65 / $645.65 / $645.65	Facility	53	$645.65	$645.65	$645.65
Medica Facility/Professional Professional Modifier Low / Median / High Price $741.31 / $1,000.00 / $5,370.32	Professional		$741.31	$1,000.00	$5,370.32
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $199.53 / $1,047.13	Professional	26	$114.82	$199.53	$1,047.13
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $630.96 / $870.96 / $4,466.84	Professional	TC	$630.96	$870.96	$4,466.84
United Facility/Professional Professional Modifier Low / Median / High Price $741.31 / $954.99 / $1,445.44	Professional		$741.31	$954.99	$1,445.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $165.96 / $263.03	Professional	26	$112.20	$165.96	$263.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $616.60 / $776.25 / $1,230.27	Professional	TC	$616.60	$776.25	$1,230.27