Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.02 / $112.52 / $161.97	Facility	26	$93.02	$112.52	$161.97
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $108.92 / $133.13 / $142.84	Facility	53	$108.92	$133.13	$142.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $665.72 / $860.94 / $1,322.02	Professional		$665.72	$860.94	$1,322.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $101.93 / $155.40 / $258.50	Professional	26	$101.93	$155.40	$258.50
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $323.49 / $377.08 / $516.04	Professional	52	$323.49	$377.08	$516.04
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $129.40 / $150.83 / $206.42	Professional	53	$129.40	$150.83	$206.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $533.63 / $714.93 / $1,039.27	Professional	TC	$533.63	$714.93	$1,039.27
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $512.57 / $512.57 / $541.01	Professional		$512.57	$512.57	$541.01
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $43.32 / $128.97 / $193.50	Professional	26	$43.32	$128.97	$193.50
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $128.13 / $128.13 / $128.13	Professional	52	$128.13	$128.13	$128.13
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $126.71 / $126.71 / $374.73	Facility	26	$126.71	$126.71	$374.73
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 $660.00 / $1,075.85 / $1,775.32	Professional		$660.00	$1,075.85	$1,775.32
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $103.68 / $196.12 / $321.60	Professional	26	$103.68	$196.12	$321.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $561.01 / $891.59 / $1,461.23	Professional	TC	$561.01	$891.59	$1,461.23
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $161.15 / $161.15 / $161.15	Facility	26	$161.15	$161.15	$161.15
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $448.50 / $757.79 / $1,024.99	Professional		$448.50	$757.79	$1,024.99
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $74.00 / $138.16 / $209.61	Professional	26	$74.00	$138.16	$209.61
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $374.50 / $596.22 / $790.02	Professional	TC	$374.50	$596.22	$790.02
Molina Facility/Professional Professional Modifier Low / Median / High Price $99.24 / $598.68 / $1,011.92	Professional		$99.24	$598.68	$1,011.92
United Facility/Professional Professional Modifier Low / Median / High Price $670.79 / $954.99 / $1,752.18	Professional		$670.79	$954.99	$1,752.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $115.52 / $179.82 / $313.20	Professional	26	$115.52	$179.82	$313.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $546.20 / $784.78 / $1,420.08	Professional	TC	$546.20	$784.78	$1,420.08
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $533.37 / $533.37 / $533.37	Professional		$533.37	$533.37	$533.37
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $84.26 / $84.26 / $84.26	Professional	26	$84.26	$84.26	$84.26
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $449.11 / $449.11 / $568.09	Professional	TC	$449.11	$449.11	$568.09