Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $143.79 / $463.11 / $3,718.00	Facility		$143.79	$463.11	$3,718.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.67 / $47.94 / $53.66	Facility	26	$32.67	$47.94	$53.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $138.88 / $172.21 / $255.98	Professional		$138.88	$172.21	$255.98
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.95 / $49.38 / $90.86	Professional	26	$37.95	$49.38	$90.86
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $508.25 / $656.49 / $813.92	Professional	52	$508.25	$656.49	$813.92
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $99.34 / $122.63 / $182.19	Professional	TC	$99.34	$122.63	$182.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $105.12 / $116.93 / $208.69	Professional		$105.12	$116.93	$208.69
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $34.53 / $44.55 / $60.86	Professional	26	$34.53	$44.55	$60.86
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $27.80 / $27.80 / $35.86	Professional	52	$27.80	$27.80	$35.86
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $101.10 / $101.10 / $101.10	Professional	TC	$101.10	$101.10	$101.10
Cigna Facility/Professional Facility Modifier Low / Median / High Price $144.52 / $298.94 / $707.00	Facility		$144.52	$298.94	$707.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.86 / $44.86 / $44.86	Facility	26	$44.86	$44.86	$44.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $127.96 / $229.81 / $394.06	Professional		$127.96	$229.81	$394.06
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.29 / $63.79 / $108.88	Professional	26	$36.29	$63.79	$108.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $93.77 / $164.94 / $281.31	Professional	TC	$93.77	$164.94	$281.31
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $83.69 / $101.63 / $212.73	Professional		$83.69	$101.63	$212.73
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $25.99 / $31.11 / $61.38	Professional	26	$25.99	$31.11	$61.38
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $57.71 / $70.13 / $151.35	Professional	TC	$57.71	$70.13	$151.35
Molina Facility/Professional Professional Modifier Low / Median / High Price $37.20 / $114.26 / $186.07	Professional		$37.20	$114.26	$186.07
United Facility/Professional Professional Modifier Low / Median / High Price $126.68 / $196.56 / $333.85	Professional		$126.68	$196.56	$333.85
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.07 / $54.12 / $102.26	Professional	26	$34.07	$54.12	$102.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $93.26 / $143.04 / $239.88	Professional	TC	$93.26	$143.04	$239.88
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $106.28 / $106.28 / $125.59	Professional		$106.28	$106.28	$125.59
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $31.75 / $31.75 / $37.13	Professional	26	$31.75	$31.75	$37.13
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $74.54 / $74.54 / $82.44	Professional	TC	$74.54	$74.54	$82.44