Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $115.40 / $115.40 / $252.32	Facility	26	$115.40	$115.40	$252.32
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $148.44 / $148.44 / $148.44	Facility	53	$148.44	$148.44	$148.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $742.21 / $1,010.53 / $1,736.12	Professional		$742.21	$1,010.53	$1,736.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $111.90 / $172.54 / $330.89	Professional	26	$111.90	$172.54	$330.89
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $347.80 / $377.08 / $409.89	Professional	52	$347.80	$377.08	$409.89
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $139.12 / $150.83 / $172.19	Professional	53	$139.12	$150.83	$172.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $626.79 / $716.88 / $1,165.53	Professional	TC	$626.79	$716.88	$1,165.53
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $449.76 / $498.41 / $623.02	Professional		$449.76	$498.41	$623.02
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $103.57 / $111.34 / $185.39	Professional	26	$103.57	$111.34	$185.39
BCBS Facility/Professional Professional Modifier Low / Median / High Price $623.02 / $1,063.00 / $1,538.80	Professional		$623.02	$1,063.00	$1,538.80
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $103.57 / $225.00 / $325.70	Professional	26	$103.57	$225.00	$325.70
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $519.44 / $838.00 / $1,113.45	Professional	TC	$519.44	$838.00	$1,113.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $850.24 / $1,029.51 / $1,653.52	Professional		$850.24	$1,029.51	$1,653.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $131.53 / $198.50 / $332.56	Professional	26	$131.53	$198.50	$332.56
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $665.50 / $855.72 / $1,318.47	Professional	TC	$665.50	$855.72	$1,318.47
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $170.07 / $235.00 / $524.29	Facility	26	$170.07	$235.00	$524.29
Medcost Facility/Professional Professional Modifier Low / Median / High Price $2,775.27 / $2,775.27 / $2,775.27	Professional		$2,775.27	$2,775.27	$2,775.27
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $411.79 / $411.79 / $411.79	Professional	26	$411.79	$411.79	$411.79
Molina Facility/Professional Professional Modifier Low / Median / High Price $96.04 / $575.81 / $925.40	Professional		$96.04	$575.81	$925.40
United Facility/Professional Professional Modifier Low / Median / High Price $791.55 / $987.77 / $1,446.70	Professional		$791.55	$987.77	$1,446.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $127.24 / $178.67 / $288.29	Professional	26	$127.24	$178.67	$288.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $619.34 / $769.83 / $1,130.48	Professional	TC	$619.34	$769.83	$1,130.48