Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.12 / $50.12 / $257.04	Facility	26	$50.12	$50.12	$257.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $234.42 / $645.65	Professional		$154.88	$234.42	$645.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $75.86 / $190.55	Professional	26	$50.12	$75.86	$190.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $144.54 / $338.84	Professional	TC	$104.71	$144.54	$338.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $169.82 / $371.54	Professional		$144.54	$169.82	$371.54
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $77.62 / $120.23	Professional	26	$57.54	$77.62	$120.23
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.62 / $85.11 / $123.03	Facility	26	$18.62	$85.11	$123.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $316.23 / $512.86	Professional		$165.96	$316.23	$512.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $85.11 / $169.82	Professional	26	$53.70	$85.11	$169.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $190.55 / $380.19	Professional	TC	$104.71	$190.55	$380.19
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $85.11 / $85.11	Facility	26	$85.11	$85.11	$85.11
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $239.88 / $371.54	Professional		$147.91	$239.88	$371.54
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $77.62 / $114.82	Professional	26	$51.29	$77.62	$114.82
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $162.18 / $245.47	Professional	TC	$95.50	$162.18	$245.47
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $112.20 / $275.42	Professional		$32.36	$112.20	$275.42
United Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $416.87 / $977.24	Professional		$194.98	$416.87	$977.24
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $69.18 / $138.04	Professional	26	$60.26	$69.18	$138.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $323.59 / $870.96	Professional	TC	$131.83	$323.59	$870.96
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 $57.54 / $57.54 / $72.44	Professional	26	$57.54	$57.54	$72.44
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $112.20 / $138.04	Professional	TC	$112.20	$112.20	$138.04