Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.50 / $71.88 / $234.94	Facility	26	$62.50	$71.88	$234.94
Aetna Facility/Professional Professional Modifier Low / Median / High Price $244.12 / $379.11 / $603.00	Professional		$244.12	$379.11	$603.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.50 / $105.88 / $180.00	Professional	26	$62.50	$105.88	$180.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $119.41 / $155.94 / $256.37	Professional	52	$119.41	$155.94	$256.37
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $171.08 / $264.32 / $426.02	Professional	TC	$171.08	$264.32	$426.02
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $137.31 / $158.47 / $215.38	Professional		$137.31	$158.47	$215.38
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $50.74 / $71.20 / $142.80	Professional	26	$50.74	$71.20	$142.80
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $112.97 / $112.97 / $112.97	Professional	TC	$112.97	$112.97	$112.97
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.45 / $79.45 / $212.11	Facility	26	$79.45	$79.45	$212.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $171.88 / $376.23 / $757.00	Professional		$171.88	$376.23	$757.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.20 / $85.31 / $142.66	Professional	26	$49.20	$85.31	$142.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $125.69 / $283.24 / $612.44	Professional	TC	$125.69	$283.24	$612.44
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $77.59 / $77.59 / $77.59	Facility	26	$77.59	$77.59	$77.59
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $254.74 / $418.80 / $560.03	Professional		$254.74	$418.80	$560.03
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $47.84 / $75.65 / $103.89	Professional	26	$47.84	$75.65	$103.89
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $176.91 / $343.19 / $472.18	Professional	TC	$176.91	$343.19	$472.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $62.75 / $162.95 / $283.67	Professional		$62.75	$162.95	$283.67
United Facility/Professional Professional Modifier Low / Median / High Price $208.14 / $335.16 / $672.72	Professional		$208.14	$335.16	$672.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.66 / $63.81 / $139.63	Professional	26	$54.66	$63.81	$139.63
United Facility/Professional Professional Modifier TC Low / Median / High Price $148.01 / $250.20 / $568.19	Professional	TC	$148.01	$250.20	$568.19
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $177.78 / $177.78 / $177.78	Professional		$177.78	$177.78	$177.78
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $51.80 / $51.80 / $51.80	Professional	26	$51.80	$51.80	$51.80
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $125.98 / $125.98 / $125.98	Professional	TC	$125.98	$125.98	$125.98