Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $101.17 / $116.66 / $165.03	Facility	26	$101.17	$116.66	$165.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $575.39 / $679.45 / $1,011.54	Professional		$575.39	$679.45	$1,011.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $111.42 / $134.63 / $256.29	Professional	26	$111.42	$134.63	$256.29
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $276.43 / $326.50 / $467.76	Professional	52	$276.43	$326.50	$467.76
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $455.27 / $544.82 / $794.38	Professional	TC	$455.27	$544.82	$794.38
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $565.88 / $618.03 / $730.16	Professional		$565.88	$618.03	$730.16
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $108.64 / $147.10 / $193.94	Professional	26	$108.64	$147.10	$193.94
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $168.69 / $168.69 / $168.69	Professional	52	$168.69	$168.69	$168.69
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $457.24 / $457.24 / $457.24	Professional	TC	$457.24	$457.24	$457.24
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $139.38 / $139.38 / $139.38	Facility	26	$139.38	$139.38	$139.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $523.64 / $891.75 / $1,724.68	Professional		$523.64	$891.75	$1,724.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $106.02 / $176.30 / $317.56	Professional	26	$106.02	$176.30	$317.56
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $443.86 / $712.45 / $1,285.33	Professional	TC	$443.86	$712.45	$1,285.33
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $425.93 / $514.09 / $757.86	Professional		$425.93	$514.09	$757.86
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $81.77 / $98.20 / $185.99	Professional	26	$81.77	$98.20	$185.99
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $344.16 / $401.87 / $549.15	Professional	TC	$344.16	$401.87	$549.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $130.25 / $553.28 / $930.64	Professional		$130.25	$553.28	$930.64
United Facility/Professional Professional Modifier Low / Median / High Price $493.61 / $778.47 / $1,306.01	Professional		$493.61	$778.47	$1,306.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $96.66 / $154.79 / $268.55	Professional	26	$96.66	$154.79	$268.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $394.55 / $610.91 / $1,026.93	Professional	TC	$394.55	$610.91	$1,026.93
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $502.99 / $502.99 / $608.47	Professional		$502.99	$502.99	$608.47
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $92.43 / $92.43 / $116.82	Professional	26	$92.43	$92.43	$116.82
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $410.56 / $410.56 / $523.09	Professional	TC	$410.56	$410.56	$523.09