Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $59.00 / $205.58	Facility	26	$51.29	$59.00	$205.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $160.07 / $200.12 / $346.24	Professional		$160.07	$200.12	$346.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.30 / $61.34 / $155.25	Professional	26	$51.30	$61.34	$155.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $99.84 / $124.48 / $221.14	Professional	TC	$99.84	$124.48	$221.14
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $91.55 / $120.81 / $247.52	Professional		$91.55	$120.81	$247.52
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $44.58 / $79.03 / $123.99	Professional	26	$44.58	$79.03	$123.99
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $85.98 / $85.98 / $85.98	Professional	TC	$85.98	$85.98	$85.98
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.79 / $69.79 / $185.62	Facility	26	$69.79	$69.79	$185.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $118.17 / $244.00 / $472.68	Professional		$118.17	$244.00	$472.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.25 / $65.76 / $126.00	Professional	26	$43.25	$65.76	$126.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $78.72 / $173.44 / $346.44	Professional	TC	$78.72	$173.44	$346.44
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $67.94 / $67.94 / $67.94	Facility	26	$67.94	$67.94	$67.94
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $151.01 / $251.33 / $332.09	Professional		$151.01	$251.33	$332.09
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $47.56 / $70.48 / $89.17	Professional	26	$47.56	$70.48	$89.17
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $98.38 / $180.86 / $244.05	Professional	TC	$98.38	$180.86	$244.05
Molina Facility/Professional Professional Modifier Low / Median / High Price $41.48 / $115.05 / $193.49	Professional		$41.48	$115.05	$193.49
United Facility/Professional Professional Modifier Low / Median / High Price $156.94 / $223.09 / $396.00	Professional		$156.94	$223.09	$396.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.39 / $55.12 / $115.59	Professional	26	$47.39	$55.12	$115.59
United Facility/Professional Professional Modifier TC Low / Median / High Price $104.74 / $158.68 / $304.45	Professional	TC	$104.74	$158.68	$304.45
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $113.32 / $113.32 / $113.32	Professional		$113.32	$113.32	$113.32
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $41.95 / $41.95 / $41.95	Professional	26	$41.95	$41.95	$41.95
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $71.38 / $71.38 / $71.38	Professional	TC	$71.38	$71.38	$71.38