Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $60.26 / $562.34	Facility	26	$51.29	$60.26	$562.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $275.42 / $602.56	Professional		$169.82	$275.42	$602.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $75.86 / $190.55	Professional	26	$51.29	$75.86	$190.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $208.93 / $398.11	Professional	TC	$120.23	$208.93	$398.11
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $173.78 / $389.05	Professional		$147.91	$173.78	$389.05
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $53.70 / $87.10	Professional	26	$40.74	$53.70	$87.10
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $112.20 / $199.53	Professional	TC	$112.20	$112.20	$199.53
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.49 / $61.66 / $107.15	Facility	26	$13.49	$61.66	$107.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $251.19 / $562.34	Professional		$162.18	$251.19	$562.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $60.26 / $117.49	Professional	26	$38.90	$60.26	$117.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $190.55 / $446.68	Professional	TC	$128.82	$190.55	$446.68
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $61.66 / $61.66 / $61.66	Facility	26	$61.66	$61.66	$61.66
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $239.88 / $338.84	Professional		$154.88	$239.88	$338.84
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $56.23 / $81.28	Professional	26	$38.02	$56.23	$81.28
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $190.55 / $269.15	Professional	TC	$114.82	$190.55	$269.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $91.20 / $263.03	Professional		$32.36	$91.20	$263.03
United Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $239.88 / $436.52	Professional		$177.83	$239.88	$436.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $50.12 / $97.72	Professional	26	$43.65	$50.12	$97.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $186.21 / $338.84	Professional	TC	$134.90	$186.21	$338.84
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $147.91 / $218.78	Professional		$147.91	$147.91	$218.78
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $34.67 / $53.70	Professional	26	$34.67	$34.67	$53.70
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $112.20 / $165.96	Professional	TC	$112.20	$112.20	$165.96