Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.66 / $64.57 / $208.93	Facility	26	$61.66	$64.57	$208.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $380.19 / $851.14	Professional		$229.09	$380.19	$851.14
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $97.72 / $194.98	Professional	26	$57.54	$97.72	$194.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $263.03 / $537.03	Professional	TC	$165.96	$263.03	$537.03
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $169.82 / $223.87	Professional		$141.25	$169.82	$223.87
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $72.44 / $93.33	Professional	26	$42.66	$72.44	$93.33
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 $162.18 / $363.08 / $758.58	Professional		$162.18	$363.08	$758.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $70.79 / $128.82	Professional	26	$40.74	$70.79	$128.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $269.15 / $645.65	Professional	TC	$131.83	$269.15	$645.65
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $64.57 / $64.57 / $64.57	Facility	26	$64.57	$64.57	$64.57
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $389.05 / $588.84	Professional		$154.88	$389.05	$588.84
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 $114.82 / $331.13 / $501.19	Professional	TC	$114.82	$331.13	$501.19
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $100.00 / $281.84	Professional		$32.36	$100.00	$281.84
United Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $331.13 / $616.60	Professional		$190.55	$331.13	$616.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $52.48 / $102.33	Professional	26	$44.67	$52.48	$102.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $257.04 / $524.81	Professional	TC	$141.25	$257.04	$524.81
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $169.82 / $208.93	Professional		$169.82	$169.82	$208.93
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 $125.89 / $125.89 / $154.88	Professional	TC	$125.89	$125.89	$154.88