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 / $246.19	Facility	26	$62.50	$68.75	$246.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $199.81 / $370.50 / $603.00	Professional		$199.81	$370.50	$603.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.50 / $117.34 / $224.15	Professional	26	$62.50	$117.34	$224.15
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $98.96 / $137.50 / $262.50	Professional	52	$98.96	$137.50	$262.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $129.40 / $245.79 / $385.24	Professional	TC	$129.40	$245.79	$385.24
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $116.08 / $145.09 / $297.27	Professional		$116.08	$145.09	$297.27
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $51.59 / $64.48 / $144.82	Professional	26	$51.59	$64.48	$144.82
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $89.24 / $91.21 / $147.59	Professional	TC	$89.24	$91.21	$147.59
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.59 / $80.59 / $216.56	Facility	26	$80.59	$80.59	$216.56
Cigna Facility/Professional Professional Modifier Low / Median / High Price $143.21 / $320.00 / $711.53	Professional		$143.21	$320.00	$711.53
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.90 / $87.70 / $149.63	Professional	26	$49.90	$87.70	$149.63
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $91.86 / $224.00 / $603.27	Professional	TC	$91.86	$224.00	$603.27
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $79.31 / $79.31 / $79.31	Facility	26	$79.31	$79.31	$79.31
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $169.00 / $270.98 / $542.72	Professional		$169.00	$270.98	$542.72
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $55.52 / $82.52 / $106.32	Professional	26	$55.52	$82.52	$106.32
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $111.51 / $178.79 / $456.41	Professional	TC	$111.51	$178.79	$456.41
Molina Facility/Professional Professional Modifier Low / Median / High Price $62.75 / $133.78 / $231.85	Professional		$62.75	$133.78	$231.85
United Facility/Professional Professional Modifier Low / Median / High Price $170.63 / $269.45 / $587.53	Professional		$170.63	$269.45	$587.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.78 / $64.23 / $135.47	Professional	26	$54.78	$64.23	$135.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $169.84 / $442.51	Professional	TC	$109.65	$169.84	$442.51
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $148.36 / $148.36 / $148.36	Professional		$148.36	$148.36	$148.36
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $52.55 / $52.55 / $52.55	Professional	26	$52.55	$52.55	$52.55
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $95.81 / $95.81 / $95.81	Professional	TC	$95.81	$95.81	$95.81