Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $42.00 / $42.00 / $42.00	Facility		$42.00	$42.00	$42.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $141.19 / $141.19 / $141.19	Facility	26	$141.19	$141.19	$141.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $73.45 / $94.89 / $242.06	Professional		$73.45	$94.89	$242.06
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.25 / $43.23 / $207.40	Professional	26	$31.25	$43.23	$207.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $41.60 / $59.84 / $100.22	Professional	TC	$41.60	$59.84	$100.22
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $55.27 / $84.90 / $130.85	Professional		$55.27	$84.90	$130.85
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $13.00 / $38.31 / $62.57	Professional	26	$13.00	$38.31	$62.57
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $48.13 / $54.17 / $56.03	Professional	TC	$48.13	$54.17	$56.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $57.10 / $103.64 / $190.81	Professional		$57.10	$103.64	$190.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.63 / $36.95 / $80.13	Professional	26	$20.63	$36.95	$80.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $36.33 / $58.51 / $123.92	Professional	TC	$36.33	$58.51	$123.92
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $86.10 / $118.56 / $217.44	Professional		$86.10	$118.56	$217.44
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $38.31 / $51.10 / $69.58	Professional	26	$38.31	$51.10	$69.58
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $45.18 / $57.61 / $108.35	Professional	TC	$45.18	$57.61	$108.35
Molina Facility/Professional Professional Modifier Low / Median / High Price $41.48 / $86.49 / $167.82	Professional		$41.48	$86.49	$167.82
United Facility/Professional Professional Modifier Low / Median / High Price $57.86 / $75.09 / $291.56	Professional		$57.86	$75.09	$291.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.98 / $31.83 / $108.68	Professional	26	$19.98	$31.83	$108.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $33.40 / $47.42 / $166.74	Professional	TC	$33.40	$47.42	$166.74
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $41.01 / $91.14 / $91.14	Professional		$41.01	$91.14	$91.14
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $13.79 / $30.64 / $30.64	Professional	26	$13.79	$30.64	$30.64
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $27.23 / $60.50 / $60.50	Professional	TC	$27.23	$60.50	$60.50