Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.29 / $38.90 / $119.32	Facility	26	$25.29	$38.90	$119.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $98.18 / $135.69 / $316.39	Professional		$98.18	$135.69	$316.39
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.19 / $38.90 / $93.10	Professional	26	$29.19	$38.90	$93.10
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $40.02 / $142.94 / $564.00	Professional	52	$40.02	$142.94	$564.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $68.31 / $96.79 / $153.28	Professional	TC	$68.31	$96.79	$153.28
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $76.41 / $100.47 / $195.69	Professional		$76.41	$100.47	$195.69
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $26.63 / $34.18 / $66.43	Professional	26	$26.63	$34.18	$66.43
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $19.10 / $25.12 / $83.57	Professional	52	$19.10	$25.12	$83.57
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $66.31 / $78.59 / $165.89	Professional	TC	$66.31	$78.59	$165.89
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.28 / $41.28 / $108.11	Facility	26	$41.28	$41.28	$108.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.53 / $149.24 / $255.56	Professional		$87.53	$149.24	$255.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.65 / $42.34 / $73.68	Professional	26	$25.65	$42.34	$73.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $61.89 / $109.39 / $191.53	Professional	TC	$61.89	$109.39	$191.53
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $45.58 / $45.58 / $45.58	Facility	26	$45.58	$45.58	$45.58
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $89.54 / $155.56 / $217.79	Professional		$89.54	$155.56	$217.79
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $25.98 / $43.06 / $59.83	Professional	26	$25.98	$43.06	$59.83
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $63.30 / $112.83 / $157.96	Professional	TC	$63.30	$112.83	$157.96
Molina Facility/Professional Professional Modifier Low / Median / High Price $36.32 / $109.46 / $189.64	Professional		$36.32	$109.46	$189.64
United Facility/Professional Professional Modifier Low / Median / High Price $102.90 / $125.80 / $236.83	Professional		$102.90	$125.80	$236.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.96 / $37.13 / $69.00	Professional	26	$28.96	$37.13	$69.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $73.81 / $92.45 / $167.99	Professional	TC	$73.81	$92.45	$167.99
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $76.19 / $76.19 / $76.19	Professional		$76.19	$76.19	$76.19
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $21.23 / $21.23 / $21.23	Professional	26	$21.23	$21.23	$21.23
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $54.96 / $54.96 / $54.96	Professional	TC	$54.96	$54.96	$54.96