Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $51.29 / $194.98	Facility	26	$51.29	$51.29	$194.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $199.53 / $602.56	Professional		$138.04	$199.53	$602.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $74.13 / $181.97	Professional	26	$51.29	$74.13	$181.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $120.23 / $251.19	Professional	TC	$81.28	$120.23	$251.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $104.71 / $134.90	Professional		$85.11	$104.71	$134.90
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $57.54 / $100.00	Professional	26	$42.66	$57.54	$100.00
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $151.36 / $151.36	Professional	TC	$151.36	$151.36	$151.36
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 $102.33 / $194.98 / $407.38	Professional		$102.33	$194.98	$407.38
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $60.26 / $120.23	Professional	26	$39.81	$60.26	$120.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $131.83 / $288.40	Professional	TC	$60.26	$131.83	$288.40
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 $97.72 / $165.96 / $269.15	Professional		$97.72	$165.96	$269.15
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $57.54 / $83.18	Professional	26	$38.90	$57.54	$83.18
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $97.72 / $194.98	Professional	TC	$57.54	$97.72	$194.98
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $64.57 / $158.49	Professional		$32.36	$64.57	$158.49
United Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $173.78 / $316.23	Professional		$114.82	$173.78	$316.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $51.29 / $100.00	Professional	26	$44.67	$51.29	$100.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $102.33 / $218.78	Professional	TC	$69.18	$102.33	$218.78
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $97.72 / $131.83	Professional		$97.72	$97.72	$131.83
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $39.81 / $54.95	Professional	26	$39.81	$39.81	$54.95
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $58.88 / $77.62	Professional	TC	$58.88	$58.88	$77.62