Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.66 / $72.44 / $575.44	Facility	26	$61.66	$72.44	$575.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $371.54 / $630.96	Professional		$234.42	$371.54	$630.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $81.28 / $154.88	Professional	26	$57.54	$81.28	$154.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $269.15 / $501.19	Professional	TC	$177.83	$269.15	$501.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $380.19 / $380.19	Professional		$380.19	$380.19	$380.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $61.66 / $91.20	Professional	26	$44.67	$61.66	$91.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.80 / $64.57 / $109.65	Facility	26	$13.80	$64.57	$109.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $389.05 / $758.58	Professional		$169.82	$389.05	$758.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $69.18 / $131.83	Professional	26	$39.81	$69.18	$131.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $288.40 / $645.65	Professional	TC	$141.25	$288.40	$645.65
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $63.10 / $63.10 / $63.10	Facility	26	$63.10	$63.10	$63.10
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $389.05 / $575.44	Professional		$162.18	$389.05	$575.44
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $60.26 / $87.10	Professional	26	$38.90	$60.26	$87.10
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $323.59 / $489.78	Professional	TC	$123.03	$323.59	$489.78
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $104.71 / $302.00	Professional		$32.36	$104.71	$302.00
United Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $331.13 / $616.60	Professional		$199.53	$331.13	$616.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $52.48 / $102.33	Professional	26	$43.65	$52.48	$102.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $263.03 / $524.81	Professional	TC	$151.36	$263.03	$524.81
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $177.83 / $218.78	Professional		$177.83	$177.83	$218.78
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $42.66 / $54.95	Professional	26	$42.66	$42.66	$54.95
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $134.90 / $165.96	Professional	TC	$134.90	$134.90	$165.96