Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $61.66 / $199.53	Facility	26	$51.29	$61.66	$199.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $234.42 / $549.54	Professional		$169.82	$234.42	$549.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $70.79 / $199.53	Professional	26	$51.29	$70.79	$199.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $165.96 / $371.54	Professional	TC	$112.20	$165.96	$371.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $186.21 / $363.08	Professional		$112.20	$186.21	$363.08
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $63.10 / $95.50	Professional	26	$43.65	$63.10	$95.50
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.13 / $66.07 / $112.20	Facility	26	$14.13	$66.07	$112.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $245.47 / $512.86	Professional		$125.89	$245.47	$512.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $63.10 / $123.03	Professional	26	$40.74	$63.10	$123.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $173.78 / $389.05	Professional	TC	$91.20	$173.78	$389.05
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $64.57 / $64.57 / $64.57	Facility	26	$64.57	$64.57	$64.57
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $234.42 / $354.81	Professional		$120.23	$234.42	$354.81
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $58.88 / $85.11	Professional	26	$39.81	$58.88	$85.11
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $162.18 / $269.15	Professional	TC	$79.43	$162.18	$269.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $85.11 / $208.93	Professional		$32.36	$85.11	$208.93
United Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $223.87 / $407.38	Professional		$154.88	$223.87	$407.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $52.48 / $102.33	Professional	26	$45.71	$52.48	$102.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $162.18 / $309.03	Professional	TC	$102.33	$162.18	$309.03
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $131.83 / $165.96	Professional		$131.83	$131.83	$165.96
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $43.65 / $56.23	Professional	26	$43.65	$43.65	$56.23
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $87.10 / $107.15	Professional	TC	$87.10	$87.10	$107.15