Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.28 / $29.52 / $327.75	Facility	26	$22.28	$29.52	$327.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $79.04 / $115.88 / $300.00	Professional		$79.04	$115.88	$300.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.28 / $33.42 / $113.81	Professional	26	$22.28	$33.42	$113.81
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $39.52 / $50.11 / $68.50	Professional	52	$39.52	$50.11	$68.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $56.76 / $80.73 / $164.46	Professional	TC	$56.76	$80.73	$164.46
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $76.66 / $95.24 / $179.51	Professional		$76.66	$95.24	$179.51
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $24.04 / $32.50 / $59.04	Professional	26	$24.04	$32.50	$59.04
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $17.52 / $21.90 / $23.05	Professional	52	$17.52	$21.90	$23.05
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $60.97 / $85.67 / $101.24	Professional	TC	$60.97	$85.67	$101.24
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.42 / $37.42 / $101.01	Facility	26	$37.42	$37.42	$101.01
Cigna Facility/Professional Professional Modifier Low / Median / High Price $82.08 / $117.26 / $237.40	Professional		$82.08	$117.26	$237.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.54 / $36.45 / $71.78	Professional	26	$23.54	$36.45	$71.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $58.54 / $83.63 / $169.54	Professional	TC	$58.54	$83.63	$169.54
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $36.81 / $36.81 / $36.81	Facility	26	$36.81	$36.81	$36.81
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $76.67 / $112.27 / $164.90	Professional		$76.67	$112.27	$164.90
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $22.15 / $36.35 / $48.31	Professional	26	$22.15	$36.35	$48.31
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $54.51 / $80.06 / $116.15	Professional	TC	$54.51	$80.06	$116.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $36.67 / $117.81 / $194.44	Professional		$36.67	$117.81	$194.44
United Facility/Professional Professional Modifier Low / Median / High Price $87.03 / $101.62 / $212.01	Professional		$87.03	$101.62	$212.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.18 / $29.06 / $53.12	Professional	26	$26.18	$29.06	$53.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $60.49 / $72.56 / $124.25	Professional	TC	$60.49	$72.56	$124.25
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $73.23 / $73.23 / $73.23	Professional		$73.23	$73.23	$73.23
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $19.84 / $19.84 / $19.84	Professional	26	$19.84	$19.84	$19.84
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $53.39 / $53.39 / $53.39	Professional	TC	$53.39	$53.39	$53.39