Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $615.69 / $615.69 / $615.69	Facility		$615.69	$615.69	$615.69
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $102.25 / $102.25 / $102.25	Facility	26	$102.25	$102.25	$102.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $73.84 / $126.79 / $272.74	Professional		$73.84	$126.79	$272.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.06 / $29.89 / $90.10	Professional	26	$24.06	$29.89	$90.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $48.14 / $91.74 / $254.11	Professional	TC	$48.14	$91.74	$254.11
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $76.81 / $83.72 / $233.65	Professional		$76.81	$83.72	$233.65
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $13.00 / $35.56 / $58.55	Professional	26	$13.00	$35.56	$58.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $59.05 / $122.46 / $252.93	Professional		$59.05	$122.46	$252.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.94 / $32.04 / $61.99	Professional	26	$18.94	$32.04	$61.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $39.71 / $83.06 / $194.26	Professional	TC	$39.71	$83.06	$194.26
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $84.06 / $124.67 / $194.24	Professional		$84.06	$124.67	$194.24
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $28.47 / $41.86 / $53.58	Professional	26	$28.47	$41.86	$53.58
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $55.59 / $82.42 / $148.65	Professional	TC	$55.59	$82.42	$148.65
Molina Facility/Professional Professional Modifier Low / Median / High Price $41.40 / $153.91 / $215.89	Professional		$41.40	$153.91	$215.89
United Facility/Professional Facility Modifier Low / Median / High Price $255.07 / $255.07 / $255.07	Facility		$255.07	$255.07	$255.07
United Facility/Professional Professional Modifier Low / Median / High Price $65.39 / $100.65 / $350.80	Professional		$65.39	$100.65	$350.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $18.19 / $24.72 / $96.70	Professional	26	$18.19	$24.72	$96.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $42.62 / $76.91 / $270.68	Professional	TC	$42.62	$76.91	$270.68
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $49.43 / $109.85 / $109.85	Professional		$49.43	$109.85	$109.85
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $10.71 / $23.80 / $23.80	Professional	26	$10.71	$23.80	$23.80
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $38.72 / $86.05 / $86.05	Professional	TC	$38.72	$86.05	$86.05