Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.70 / $59.00 / $208.53	Facility	26	$50.70	$59.00	$208.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $171.00 / $240.82 / $383.18	Professional		$171.00	$240.82	$383.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.30 / $56.76 / $86.00	Professional	26	$51.30	$56.76	$86.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $119.70 / $168.52 / $300.36	Professional	TC	$119.70	$168.52	$300.36
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $130.16 / $130.16 / $130.16	Professional		$130.16	$130.16	$130.16
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $43.83 / $71.68 / $122.66	Professional	26	$43.83	$71.68	$122.66
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $68.70 / $68.70 / $185.02	Facility	26	$68.70	$68.70	$185.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $147.75 / $297.23 / $595.00	Professional		$147.75	$297.23	$595.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.79 / $70.50 / $125.63	Professional	26	$42.79	$70.50	$125.63
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $104.70 / $230.30 / $478.44	Professional	TC	$104.70	$230.30	$478.44
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $67.20 / $67.20 / $67.20	Facility	26	$67.20	$67.20	$67.20
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $185.96 / $308.00 / $429.10	Professional		$185.96	$308.00	$429.10
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $47.05 / $69.73 / $88.21	Professional	26	$47.05	$69.73	$88.21
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $128.35 / $239.39 / $357.22	Professional	TC	$128.35	$239.39	$357.22
Molina Facility/Professional Professional Modifier Low / Median / High Price $41.40 / $158.75 / $277.26	Professional		$41.40	$158.75	$277.26
United Facility/Professional Professional Modifier Low / Median / High Price $179.06 / $262.85 / $502.98	Professional		$179.06	$262.85	$502.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.70 / $54.12 / $111.18	Professional	26	$46.70	$54.12	$111.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $127.41 / $199.48 / $418.45	Professional	TC	$127.41	$199.48	$418.45
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $153.13 / $153.13 / $153.13	Professional		$153.13	$153.13	$153.13
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $44.76 / $44.76 / $44.76	Professional	26	$44.76	$44.76	$44.76
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $108.38 / $108.38 / $108.38	Professional	TC	$108.38	$108.38	$108.38