Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $56.76 / $186.18	Facility	26	$51.29	$56.76	$186.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $149.97 / $187.10 / $300.00	Professional		$149.97	$187.10	$300.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.56 / $54.20 / $96.03	Professional	26	$47.56	$54.20	$96.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $96.63 / $119.93 / $229.28	Professional	TC	$96.63	$119.93	$229.28
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $56.33 / $98.57 / $316.85	Professional		$56.33	$98.57	$316.85
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $37.00 / $61.67 / $109.52	Professional	26	$37.00	$61.67	$109.52
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.34 / $61.34 / $165.52	Facility	26	$61.34	$61.34	$165.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $104.80 / $210.39 / $430.23	Professional		$104.80	$210.39	$430.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.01 / $60.93 / $117.08	Professional	26	$38.01	$60.93	$117.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $70.77 / $145.35 / $321.50	Professional	TC	$70.77	$145.35	$321.50
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $59.73 / $59.73 / $59.73	Facility	26	$59.73	$59.73	$59.73
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $118.17 / $192.03 / $292.31	Professional		$118.17	$192.03	$292.31
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $41.81 / $61.67 / $78.39	Professional	26	$41.81	$61.67	$78.39
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $79.09 / $126.81 / $214.09	Professional	TC	$79.09	$126.81	$214.09
Molina Facility/Professional Professional Modifier Low / Median / High Price $38.81 / $112.20 / $192.04	Professional		$38.81	$112.20	$192.04
United Facility/Professional Professional Modifier Low / Median / High Price $126.14 / $182.22 / $350.32	Professional		$126.14	$182.22	$350.32
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.28 / $48.49 / $101.45	Professional	26	$41.28	$48.49	$101.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $80.94 / $126.06 / $249.12	Professional	TC	$80.94	$126.06	$249.12
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $97.74 / $97.74 / $97.74	Professional		$97.74	$97.74	$97.74
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $34.08 / $34.08 / $34.08	Professional	26	$34.08	$34.08	$34.08
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $63.66 / $63.66 / $63.66	Professional	TC	$63.66	$63.66	$63.66