Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.50 / $68.75 / $238.26	Facility	26	$62.50	$68.75	$238.26
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $50.00 / $77.40 / $132.52	Facility	53	$50.00	$77.40	$132.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $207.91 / $362.14 / $613.25	Professional		$207.91	$362.14	$613.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.50 / $106.93 / $288.00	Professional	26	$62.50	$106.93	$288.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $101.66 / $137.50 / $262.50	Professional	52	$101.66	$137.50	$262.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $134.44 / $237.13 / $384.95	Professional	TC	$134.44	$237.13	$384.95
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $119.19 / $156.31 / $305.25	Professional		$119.19	$156.31	$305.25
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $51.57 / $70.59 / $144.82	Professional	26	$51.57	$70.59	$144.82
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $90.24 / $129.12 / $155.83	Professional	TC	$90.24	$129.12	$155.83
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.26 / $80.26 / $216.56	Facility	26	$80.26	$80.26	$216.56
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $45.11 / $45.11 / $45.11	Facility	53	$45.11	$45.11	$45.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $146.76 / $325.00 / $719.85	Professional		$146.76	$325.00	$719.85
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.90 / $86.98 / $148.46	Professional	26	$49.90	$86.98	$148.46
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $95.41 / $227.50 / $606.40	Professional	TC	$95.41	$227.50	$606.40
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $78.31 / $78.31 / $78.31	Facility	26	$78.31	$78.31	$78.31
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $174.12 / $279.20 / $511.58	Professional		$174.12	$279.20	$511.58
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $54.82 / $81.25 / $104.85	Professional	26	$54.82	$81.25	$104.85
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $117.35 / $188.16 / $431.89	Professional	TC	$117.35	$188.16	$431.89
Molina Facility/Professional Professional Modifier Low / Median / High Price $62.75 / $133.84 / $232.42	Professional		$62.75	$133.84	$232.42
United Facility/Professional Professional Modifier Low / Median / High Price $175.13 / $271.97 / $601.20	Professional		$175.13	$271.97	$601.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.11 / $63.33 / $140.19	Professional	26	$54.11	$63.33	$140.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $114.15 / $172.94 / $428.01	Professional	TC	$114.15	$172.94	$428.01
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $152.13 / $152.13 / $152.13	Professional		$152.13	$152.13	$152.13
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $52.30 / $52.30 / $52.30	Professional	26	$52.30	$52.30	$52.30
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $99.83 / $99.83 / $99.83	Professional	TC	$99.83	$99.83	$99.83