Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.05 / $25.12 / $275.42	Facility	26	$19.05	$25.12	$275.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $112.20 / $213.80	Professional		$85.11	$112.20	$213.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $25.70 / $69.18	Professional	26	$19.05	$25.70	$69.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $85.11 / $154.88	Professional	TC	$66.07	$85.11	$154.88
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $87.10 / $288.40	Professional		$87.10	$87.10	$288.40
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $37.15 / $44.67	Professional	26	$36.31	$37.15	$44.67
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.76 / $31.62 / $53.70	Facility	26	$6.76	$31.62	$53.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $109.65 / $234.42	Professional		$75.86	$109.65	$234.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $30.20 / $63.10	Professional	26	$19.95	$30.20	$63.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $85.11 / $194.98	Professional	TC	$56.23	$85.11	$194.98
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $30.90 / $30.90 / $30.90	Facility	26	$30.90	$30.90	$30.90
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $100.00 / $154.88	Professional		$77.62	$100.00	$154.88
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $26.92 / $40.74	Professional	26	$19.95	$26.92	$40.74
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $75.86 / $120.23	Professional	TC	$53.70	$75.86	$120.23
Molina Facility/Professional Professional Modifier Low / Median / High Price $17.38 / $41.69 / $131.83	Professional		$17.38	$41.69	$131.83
United Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $102.33 / $186.21	Professional		$77.62	$102.33	$186.21
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $25.70 / $48.98	Professional	26	$20.89	$25.70	$48.98
United Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $75.86 / $141.25	Professional	TC	$56.23	$75.86	$141.25
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $70.79 / $128.82	Professional		$70.79	$70.79	$128.82
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $15.85 / $28.18	Professional	26	$15.85	$15.85	$28.18
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $54.95 / $100.00	Professional	TC	$54.95	$54.95	$100.00