Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.50 / $68.37 / $219.32	Facility	26	$62.50	$68.37	$219.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $208.69 / $375.00 / $818.90	Professional		$208.69	$375.00	$818.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.50 / $108.57 / $200.20	Professional	26	$62.50	$108.57	$200.20
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $1,908.64 / $1,908.64 / $3,260.00	Professional	50	$1,908.64	$1,908.64	$3,260.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $104.35 / $137.50 / $239.86	Professional	52	$104.35	$137.50	$239.86
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $147.21 / $249.00 / $415.70	Professional	TC	$147.21	$249.00	$415.70
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $122.83 / $154.13 / $206.08	Professional		$122.83	$154.13	$206.08
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $47.07 / $59.52 / $116.99	Professional	26	$47.07	$59.52	$116.99
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $99.19 / $102.60 / $167.32	Professional	TC	$99.19	$102.60	$167.32
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $73.64 / $73.64 / $198.04	Facility	26	$73.64	$73.64	$198.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $151.54 / $320.05 / $704.31	Professional		$151.54	$320.05	$704.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.80 / $79.18 / $136.86	Professional	26	$45.80	$79.18	$136.86
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $301.29 / $301.29 / $301.29	Professional	50	$301.29	$301.29	$301.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $104.42 / $231.00 / $589.80	Professional	TC	$104.42	$231.00	$589.80
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $72.55 / $72.55 / $72.55	Facility	26	$72.55	$72.55	$72.55
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $179.16 / $287.27 / $492.05	Professional		$179.16	$287.27	$492.05
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $45.59 / $71.02 / $97.26	Professional	26	$45.59	$71.02	$97.26
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $126.57 / $202.94 / $421.03	Professional	TC	$126.57	$202.94	$421.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $61.30 / $135.62 / $257.07	Professional		$61.30	$135.62	$257.07
United Facility/Professional Professional Modifier Low / Median / High Price $176.08 / $256.85 / $591.69	Professional		$176.08	$256.85	$591.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.65 / $58.31 / $124.08	Professional	26	$50.65	$58.31	$124.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $123.52 / $179.44 / $426.60	Professional	TC	$123.52	$179.44	$426.60
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $157.41 / $157.41 / $157.41	Professional		$157.41	$157.41	$157.41
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $48.03 / $48.03 / $48.03	Professional	26	$48.03	$48.03	$48.03
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $109.38 / $109.38 / $109.38	Professional	TC	$109.38	$109.38	$109.38