Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $120.21 / $252.06 / $367.99	Facility	26	$120.21	$252.06	$367.99
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $156.38 / $161.18 / $414.86	Facility	53	$156.38	$161.18	$414.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $767.61 / $954.60 / $1,595.86	Professional		$767.61	$954.60	$1,595.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $116.25 / $158.24 / $252.06	Professional	26	$116.25	$158.24	$252.06
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $361.16 / $414.74 / $534.62	Professional	52	$361.16	$414.74	$534.62
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $144.46 / $165.89 / $213.85	Professional	53	$144.46	$165.89	$213.85
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $627.80 / $767.25 / $1,108.33	Professional	TC	$627.80	$767.25	$1,108.33
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $1,126.41 / $1,126.41 / $1,126.41	Professional		$1,126.41	$1,126.41	$1,126.41
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $129.00 / $129.00 / $194.26	Professional	26	$129.00	$129.00	$194.26
BCBS Facility/Professional Professional Modifier Low / Median / High Price $804.13 / $1,111.33 / $1,795.34	Professional		$804.13	$1,111.33	$1,795.34
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $131.37 / $222.32 / $329.20	Professional	26	$131.37	$222.32	$329.20
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $663.62 / $909.15 / $1,519.36	Professional	TC	$663.62	$909.15	$1,519.36
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $126.71 / $126.71 / $171.30	Facility	26	$126.71	$126.71	$171.30
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 $726.43 / $1,040.43 / $1,747.61	Professional		$726.43	$1,040.43	$1,747.61
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $119.06 / $197.55 / $330.34	Professional	26	$119.06	$197.55	$330.34
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $606.54 / $848.23 / $1,436.64	Professional	TC	$606.54	$848.23	$1,436.64
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $259.19 / $789.30 / $789.30	Facility	26	$259.19	$789.30	$789.30
Lucent Health Facility/Professional Facility Modifier 53 Low / Median / High Price $271.97 / $754.92 / $754.92	Facility	53	$271.97	$754.92	$754.92
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $5,332.25 / $5,492.22 / $5,862.60	Professional		$5,332.25	$5,492.22	$5,862.60
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $942.99 / $1,044.83 / $1,044.83	Professional	26	$942.99	$1,044.83	$1,044.83
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $4,416.72 / $4,549.22 / $4,976.85	Professional	TC	$4,416.72	$4,549.22	$4,976.85
United Facility/Professional Professional Modifier Low / Median / High Price $807.54 / $1,062.89 / $1,760.06	Professional		$807.54	$1,062.89	$1,760.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $126.48 / $210.76 / $298.70	Professional	26	$126.48	$210.76	$298.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $683.12 / $852.61 / $1,485.05	Professional	TC	$683.12	$852.61	$1,485.05