Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $51.29 / $125.89	Facility	26	$51.29	$51.29	$125.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $223.87 / $691.83	Professional		$128.82	$223.87	$691.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $57.54 / $186.21	Professional	26	$38.02	$57.54	$186.21
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $194.98 / $194.98 / $194.98	Professional	52	$194.98	$194.98	$194.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $134.90 / $281.84	Professional	TC	$87.10	$134.90	$281.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $104.71 / $194.98	Professional		$85.11	$104.71	$194.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $41.69 / $67.61	Professional	26	$30.20	$41.69	$67.61
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $69.18 / $158.49	Professional	TC	$58.88	$69.18	$158.49
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.00 / $46.77 / $79.43	Facility	26	$10.00	$46.77	$79.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $190.55 / $398.11	Professional		$95.50	$190.55	$398.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $57.54 / $97.72	Professional	26	$28.84	$57.54	$97.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $134.90 / $288.40	Professional	TC	$66.07	$134.90	$288.40
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $45.71 / $45.71 / $45.71	Facility	26	$45.71	$45.71	$45.71
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $154.88 / $245.47	Professional		$91.20	$154.88	$245.47
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $47.86 / $66.07	Professional	26	$28.18	$47.86	$66.07
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $104.71 / $177.83	Professional	TC	$63.10	$104.71	$177.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $63.10 / $162.18	Professional		$32.36	$63.10	$162.18
United Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $165.96 / $295.12	Professional		$109.65	$165.96	$295.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $43.65 / $77.62	Professional	26	$34.67	$43.65	$77.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $117.49 / $218.78	Professional	TC	$74.13	$117.49	$218.78
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $97.72 / $125.89	Professional		$97.72	$97.72	$125.89
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $30.90 / $39.81	Professional	26	$30.90	$30.90	$39.81
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $67.61 / $85.11	Professional	TC	$67.61	$67.61	$85.11