Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $215.50 / $3,000.00 / $11,550.00	Facility		$215.50	$3,000.00	$11,550.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.72 / $35.84 / $36.97	Facility	26	$33.72	$35.84	$36.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $96.43 / $154.16 / $472.50	Professional		$96.43	$154.16	$472.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.84 / $40.25 / $68.79	Professional	26	$35.84	$40.25	$68.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $60.59 / $94.09 / $178.40	Professional	TC	$60.59	$94.09	$178.40
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $154.44 / $154.44 / $227.58	Professional		$154.44	$154.44	$227.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $133.59 / $196.48 / $346.34	Professional		$133.59	$196.48	$346.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.79 / $57.08 / $87.78	Professional	26	$33.79	$57.08	$87.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $88.95 / $143.58 / $251.62	Professional	TC	$88.95	$143.58	$251.62
Florida Blue Facility/Professional Facility Modifier Low / Median / High Price $208.88 / $414.73 / $655.04	Facility		$208.88	$414.73	$655.04
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $98.69 / $115.62 / $205.00	Professional		$98.69	$115.62	$205.00
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $26.82 / $28.74 / $88.80	Professional	26	$26.82	$28.74	$88.80
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $67.44 / $86.88 / $152.82	Professional	TC	$67.44	$86.88	$152.82
Molina Facility/Professional Professional Modifier Low / Median / High Price $37.24 / $154.95 / $231.64	Professional		$37.24	$154.95	$231.64
United Facility/Professional Facility Modifier Low / Median / High Price $345.00 / $1,911.00 / $4,970.00	Facility		$345.00	$1,911.00	$4,970.00
United Facility/Professional Professional Modifier Low / Median / High Price $116.46 / $186.53 / $331.06	Professional		$116.46	$186.53	$331.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.92 / $53.02 / $88.54	Professional	26	$34.92	$53.02	$88.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $81.97 / $134.63 / $231.13	Professional	TC	$81.97	$134.63	$231.13
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $124.78 / $124.78 / $124.78	Professional		$124.78	$124.78	$124.78
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $29.32 / $29.32 / $39.57	Professional	26	$29.32	$29.32	$39.57
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $95.46 / $95.46 / $122.99	Professional	TC	$95.46	$95.46	$122.99