Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $61.92 / $201.62	Facility	26	$51.29	$61.92	$201.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $170.96 / $215.51 / $347.11	Professional		$170.96	$215.51	$347.11
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.90 / $56.13 / $95.74	Professional	26	$50.90	$56.13	$95.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $113.33 / $141.25 / $264.02	Professional	TC	$113.33	$141.25	$264.02
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $111.68 / $111.68 / $111.68	Professional		$111.68	$111.68	$111.68
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $43.54 / $74.53 / $118.60	Professional	26	$43.54	$74.53	$118.60
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $65.98 / $65.98 / $177.59	Facility	26	$65.98	$65.98	$177.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $123.01 / $270.55 / $507.07	Professional		$123.01	$270.55	$507.07
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.82 / $65.37 / $123.94	Professional	26	$40.82	$65.37	$123.94
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $83.80 / $198.12 / $402.89	Professional	TC	$83.80	$198.12	$402.89
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $64.68 / $64.68 / $64.68	Facility	26	$64.68	$64.68	$64.68
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $159.54 / $257.13 / $361.06	Professional		$159.54	$257.13	$361.06
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $45.28 / $67.11 / $84.89	Professional	26	$45.28	$67.11	$84.89
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $104.33 / $194.45 / $285.86	Professional	TC	$104.33	$194.45	$285.86
Molina Facility/Professional Professional Modifier Low / Median / High Price $41.40 / $124.22 / $223.01	Professional		$41.40	$124.22	$223.01
United Facility/Professional Professional Modifier Low / Median / High Price $153.03 / $224.12 / $433.34	Professional		$153.03	$224.12	$433.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.97 / $51.88 / $106.69	Professional	26	$44.97	$51.88	$106.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $103.09 / $155.86 / $322.17	Professional	TC	$103.09	$155.86	$322.17
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $130.51 / $130.51 / $130.51	Professional		$130.51	$130.51	$130.51
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $43.00 / $43.00 / $43.00	Professional	26	$43.00	$43.00	$43.00
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $87.51 / $87.51 / $87.51	Professional	TC	$87.51	$87.51	$87.51