Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.50 / $68.75 / $239.79	Facility	26	$62.50	$68.75	$239.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $199.49 / $375.00 / $655.50	Professional		$199.49	$375.00	$655.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.50 / $112.50 / $233.00	Professional	26	$62.50	$112.50	$233.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $98.80 / $134.87 / $237.50	Professional	52	$98.80	$134.87	$237.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $126.37 / $226.62 / $369.35	Professional	TC	$126.37	$226.62	$369.35
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $115.23 / $138.28 / $296.27	Professional		$115.23	$138.28	$296.27
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.06 / $70.80 / $144.82	Professional	26	$52.06	$70.80	$144.82
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $85.84 / $105.27 / $149.02	Professional	TC	$85.84	$105.27	$149.02
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.26 / $80.26 / $216.56	Facility	26	$80.26	$80.26	$216.56
Cigna Facility/Professional Professional Modifier Low / Median / High Price $142.72 / $320.00 / $691.85	Professional		$142.72	$320.00	$691.85
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.90 / $89.87 / $154.03	Professional	26	$49.90	$89.87	$154.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $91.38 / $224.00 / $571.72	Professional	TC	$91.38	$224.00	$571.72
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $78.94 / $78.94 / $78.94	Facility	26	$78.94	$78.94	$78.94
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $169.53 / $271.83 / $502.23	Professional		$169.53	$271.83	$502.23
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $55.26 / $83.88 / $106.57	Professional	26	$55.26	$83.88	$106.57
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $112.29 / $180.06 / $421.03	Professional	TC	$112.29	$180.06	$421.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $62.75 / $133.78 / $231.64	Professional		$62.75	$133.78	$231.64
United Facility/Professional Professional Modifier Low / Median / High Price $170.36 / $269.02 / $593.65	Professional		$170.36	$269.02	$593.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $55.49 / $64.79 / $134.15	Professional	26	$55.49	$64.79	$134.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.38 / $173.23 / $445.70	Professional	TC	$109.38	$173.23	$445.70
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $147.86 / $147.86 / $147.86	Professional		$147.86	$147.86	$147.86
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $52.30 / $52.30 / $52.30	Professional	26	$52.30	$52.30	$52.30
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $95.55 / $95.55 / $95.55	Professional	TC	$95.55	$95.55	$95.55