Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.66 / $69.18 / $199.53	Facility	26	$61.66	$69.18	$199.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $338.84 / $1,318.26	Professional		$134.90	$338.84	$1,318.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $112.20 / $281.84	Professional	26	$61.66	$112.20	$281.84
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $288.40 / $660.69 / $3,235.94	Professional	50	$288.40	$660.69	$3,235.94
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $107.15 / $107.15 / $407.38	Professional	52	$107.15	$107.15	$407.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $257.04 / $524.81	Professional	TC	$144.54	$257.04	$524.81
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $162.18 / $257.04	Professional		$134.90	$162.18	$257.04
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $63.10 / $112.20	Professional	26	$47.86	$63.10	$112.20
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $223.87 / $223.87 / $229.09	Professional	50	$223.87	$223.87	$229.09
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $112.20 / $251.19	Professional	TC	$102.33	$112.20	$251.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.49 / $72.44 / $125.89	Facility	26	$15.49	$72.44	$125.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $323.59 / $707.95	Professional		$151.36	$323.59	$707.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $79.43 / $138.04	Professional	26	$45.71	$79.43	$138.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $229.09 / $549.54	Professional	TC	$107.15	$229.09	$549.54
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $72.44 / $72.44 / $72.44	Facility	26	$72.44	$72.44	$72.44
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $263.03 / $436.52	Professional		$147.91	$263.03	$436.52
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $63.10 / $97.72	Professional	26	$44.67	$63.10	$97.72
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $186.21 / $371.54	Professional	TC	$100.00	$186.21	$371.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $93.33 / $263.03	Professional		$32.36	$93.33	$263.03
United Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $269.15 / $562.34	Professional		$181.97	$269.15	$562.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $60.26 / $120.23	Professional	26	$51.29	$60.26	$120.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $186.21 / $426.58	Professional	TC	$123.03	$186.21	$426.58
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $158.49 / $199.53	Professional		$158.49	$158.49	$199.53
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $48.98 / $63.10	Professional	26	$48.98	$48.98	$63.10
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $109.65 / $134.90	Professional	TC	$109.65	$109.65	$134.90