Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.50 / $91.13 / $294.93	Facility	26	$62.50	$91.13	$294.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $250.00 / $392.52 / $582.00	Professional		$250.00	$392.52	$582.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.50 / $109.24 / $173.30	Professional	26	$62.50	$109.24	$173.30
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $125.00 / $172.18 / $262.50	Professional	52	$125.00	$172.18	$262.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $187.50 / $273.82 / $385.92	Professional	TC	$187.50	$273.82	$385.92
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $155.35 / $179.11 / $188.20	Professional		$155.35	$179.11	$188.20
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $59.86 / $109.73 / $178.87	Professional	26	$59.86	$109.73	$178.87
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $132.58 / $132.58 / $132.58	Professional	TC	$132.58	$132.58	$132.58
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.46 / $96.46 / $259.14	Facility	26	$96.46	$96.46	$259.14
Cigna Facility/Professional Professional Modifier Low / Median / High Price $202.80 / $413.29 / $870.99	Professional		$202.80	$413.29	$870.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.16 / $104.52 / $175.22	Professional	26	$60.16	$104.52	$175.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $141.30 / $295.39 / $702.67	Professional	TC	$141.30	$295.39	$702.67
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $94.73 / $94.73 / $94.73	Facility	26	$94.73	$94.73	$94.73
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $233.89 / $387.20 / $643.51	Professional		$233.89	$387.20	$643.51
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $66.31 / $98.56 / $126.98	Professional	26	$66.31	$98.56	$126.98
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $172.79 / $277.07 / $504.68	Professional	TC	$172.79	$277.07	$504.68
Molina Facility/Professional Professional Modifier Low / Median / High Price $95.09 / $203.78 / $357.88	Professional		$95.09	$203.78	$357.88
United Facility/Professional Professional Modifier Low / Median / High Price $241.55 / $370.65 / $753.85	Professional		$241.55	$370.65	$753.85
United Facility/Professional Professional Modifier 26 Low / Median / High Price $65.95 / $76.98 / $167.10	Professional	26	$65.95	$76.98	$167.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $168.50 / $266.77 / $580.86	Professional	TC	$168.50	$266.77	$580.86
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $197.57 / $197.57 / $197.57	Professional		$197.57	$197.57	$197.57
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $59.22 / $59.22 / $59.22	Professional	26	$59.22	$59.22	$59.22
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $138.35 / $138.35 / $138.35	Professional	TC	$138.35	$138.35	$138.35