Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $245.47 / $251.19 / $251.19	Facility	26	$245.47	$251.19	$251.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $707.95 / $1,047.13 / $2,754.23	Professional		$707.95	$1,047.13	$2,754.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $186.21 / $602.56	Professional	26	$107.15	$186.21	$602.56
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $275.42 / $794.33 / $891.25	Professional	52	$275.42	$794.33	$891.25
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 $588.84 / $758.58 / $1,348.96	Professional	TC	$588.84	$758.58	$1,348.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $741.31 / $1,348.96	Professional		$467.74	$741.31	$1,348.96
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $141.25 / $162.18	Professional	26	$91.20	$141.25	$162.18
BCBS Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $954.99 / $1,778.28	Professional		$630.96	$954.99	$1,778.28
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $223.87 / $346.74	Professional	26	$141.25	$223.87	$346.74
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $691.83 / $1,000.00 / $1,584.89	Professional	TC	$691.83	$1,000.00	$1,584.89
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $169.82 / $169.82 / $169.82	Facility	26	$169.82	$169.82	$169.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $776.25 / $1,023.29 / $1,659.59	Professional		$776.25	$1,023.29	$1,659.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $199.53 / $316.23	Professional	26	$120.23	$199.53	$316.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $630.96 / $831.76 / $1,380.38	Professional	TC	$630.96	$831.76	$1,380.38
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $794.33 / $794.33 / $794.33	Facility	26	$794.33	$794.33	$794.33
Lucent Health Facility/Professional Facility Modifier 53 Low / Median / High Price $1,000.00 / $1,000.00 / $1,000.00	Facility	53	$1,000.00	$1,000.00	$1,000.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $5,495.41 / $5,888.44 / $5,888.44	Professional		$5,495.41	$5,888.44	$5,888.44
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $933.25 / $933.25 / $1,047.13	Professional	26	$933.25	$933.25	$1,047.13
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $4,570.88 / $5,011.87 / $5,011.87	Professional	TC	$4,570.88	$5,011.87	$5,011.87
United Facility/Professional Professional Modifier Low / Median / High Price $794.33 / $1,023.29 / $1,698.24	Professional		$794.33	$1,023.29	$1,698.24
United Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $194.98 / $302.00	Professional	26	$120.23	$194.98	$302.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $660.69 / $812.83 / $1,380.38	Professional	TC	$660.69	$812.83	$1,380.38