Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $51.52 / $205.58	Facility	26	$51.29	$51.52	$205.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $152.54 / $190.50 / $300.00	Professional		$152.54	$190.50	$300.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.30 / $60.68 / $121.33	Professional	26	$51.30	$60.68	$121.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $91.90 / $119.70 / $220.00	Professional	TC	$91.90	$119.70	$220.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $88.87 / $107.82 / $320.92	Professional		$88.87	$107.82	$320.92
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $44.55 / $62.56 / $124.66	Professional	26	$44.55	$62.56	$124.66
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.44 / $69.44 / $186.61	Facility	26	$69.44	$69.44	$186.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $111.00 / $213.54 / $413.75	Professional		$111.00	$213.54	$413.75
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.25 / $65.89 / $126.49	Professional	26	$43.25	$65.89	$126.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $67.48 / $144.01 / $285.00	Professional	TC	$67.48	$144.01	$285.00
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 $138.08 / $213.40 / $287.79	Professional		$138.08	$213.40	$287.79
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 $84.09 / $146.19 / $204.00	Professional	TC	$84.09	$146.19	$204.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $41.36 / $113.29 / $192.18	Professional		$41.36	$113.29	$192.18
United Facility/Professional Professional Modifier Low / Median / High Price $129.36 / $185.41 / $334.18	Professional		$129.36	$185.41	$334.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.20 / $55.59 / $121.24	Professional	26	$47.20	$55.59	$121.24
United Facility/Professional Professional Modifier TC Low / Median / High Price $76.87 / $121.69 / $245.05	Professional	TC	$76.87	$121.69	$245.05
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $100.64 / $100.64 / $100.64	Professional		$100.64	$100.64	$100.64
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $39.29 / $39.29 / $39.29	Professional	26	$39.29	$39.29	$39.29
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $61.34 / $61.34 / $61.34	Professional	TC	$61.34	$61.34	$61.34