Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.50 / $92.55 / $367.37	Facility	26	$62.50	$92.55	$367.37
Aetna Facility/Professional Professional Modifier Low / Median / High Price $250.00 / $425.00 / $951.15	Professional		$250.00	$425.00	$951.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.50 / $136.65 / $405.26	Professional	26	$62.50	$136.65	$405.26
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $125.00 / $195.49 / $275.00	Professional	52	$125.00	$195.49	$275.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $187.50 / $297.18 / $499.00	Professional	TC	$187.50	$297.18	$499.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $192.43 / $254.03 / $495.68	Professional		$192.43	$254.03	$495.68
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $79.92 / $109.55 / $229.44	Professional	26	$79.92	$109.55	$229.44
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $126.23 / $157.79 / $387.78	Professional	TC	$126.23	$157.79	$387.78
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $123.88 / $123.88 / $331.68	Facility	26	$123.88	$123.88	$331.68
Cigna Facility/Professional Professional Modifier Low / Median / High Price $239.18 / $490.63 / $1,276.40	Professional		$239.18	$490.63	$1,276.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $76.95 / $126.00 / $226.35	Professional	26	$76.95	$126.00	$226.35
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $160.02 / $340.20 / $1,120.83	Professional	TC	$160.02	$340.20	$1,120.83
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $121.52 / $121.52 / $121.52	Facility	26	$121.52	$121.52	$121.52
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $284.81 / $456.68 / $975.75	Professional		$284.81	$456.68	$975.75
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $85.06 / $126.44 / $162.90	Professional	26	$85.06	$126.44	$162.90
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $196.70 / $315.39 / $859.45	Professional	TC	$196.70	$315.39	$859.45
Molina Facility/Professional Professional Modifier Low / Median / High Price $95.09 / $209.28 / $387.38	Professional		$95.09	$209.28	$387.38
United Facility/Professional Professional Modifier Low / Median / High Price $285.76 / $432.93 / $1,061.77	Professional		$285.76	$432.93	$1,061.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $85.08 / $98.80 / $216.45	Professional	26	$85.08	$98.80	$216.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $191.99 / $287.99 / $790.16	Professional	TC	$191.99	$287.99	$790.16
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $237.67 / $237.67 / $237.67	Professional		$237.67	$237.67	$237.67
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $77.69 / $77.69 / $77.69	Professional	26	$77.69	$77.69	$77.69
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $159.97 / $159.97 / $159.97	Professional	TC	$159.97	$159.97	$159.97