Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $112.20 / $162.18	Facility	26	$100.00	$112.20	$162.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $691.83 / $954.99 / $2,290.87	Professional		$691.83	$954.99	$2,290.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $181.97 / $549.54	Professional	26	$107.15	$181.97	$549.54
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $213.80 / $794.33 / $1,071.52	Professional	52	$213.80	$794.33	$1,071.52
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $398.11 / $549.54 / $1,698.24	Professional	53	$398.11	$549.54	$1,698.24
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $562.34 / $741.31 / $1,445.44	Professional	TC	$562.34	$741.31	$1,445.44
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $562.34 / $954.99	Professional		$501.19	$562.34	$954.99
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $158.49 / $213.80	Professional	26	$93.33	$158.49	$213.80
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.92 / $125.89 / $213.80	Facility	26	$26.92	$125.89	$213.80
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $36.31 / $181.97 / $213.80	Facility	53	$36.31	$181.97	$213.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $676.08 / $1,071.52 / $1,862.09	Professional		$676.08	$1,071.52	$1,862.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $199.53 / $338.84	Professional	26	$107.15	$199.53	$338.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $575.44 / $870.96 / $1,584.89	Professional	TC	$575.44	$870.96	$1,584.89
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $162.18 / $162.18 / $162.18	Facility	26	$162.18	$162.18	$162.18
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $676.08 / $1,047.13	Professional		$512.86	$676.08	$1,047.13
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $112.20 / $204.17	Professional	26	$81.28	$112.20	$204.17
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $389.05 / $524.81 / $891.25	Professional	TC	$389.05	$524.81	$891.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $426.58 / $1,071.52	Professional		$32.36	$426.58	$1,071.52
United Facility/Professional Professional Modifier Low / Median / High Price $676.08 / $933.25 / $1,698.24	Professional		$676.08	$933.25	$1,698.24
United Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $173.78 / $302.00	Professional	26	$109.65	$173.78	$302.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $549.54 / $758.58 / $1,412.54	Professional	TC	$549.54	$758.58	$1,412.54
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $537.03 / $776.25	Professional		$537.03	$537.03	$776.25
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $85.11 / $117.49	Professional	26	$85.11	$85.11	$117.49
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $446.68 / $446.68 / $660.69	Professional	TC	$446.68	$446.68	$660.69