Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.23 / $22.77 / $90.99	Facility	26	$18.23	$22.77	$90.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $83.09 / $107.99 / $158.53	Professional		$83.09	$107.99	$158.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.23 / $24.09 / $43.46	Professional	26	$18.23	$24.09	$43.46
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $64.86 / $83.70 / $125.78	Professional	TC	$64.86	$83.70	$125.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $83.79 / $83.79 / $269.33	Professional		$83.79	$83.79	$269.33
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $20.32 / $42.42 / $53.52	Professional	26	$20.32	$42.42	$53.52
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.37 / $30.37 / $79.54	Facility	26	$30.37	$30.37	$79.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $77.20 / $116.43 / $233.39	Professional		$77.20	$116.43	$233.39
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.09 / $30.32 / $54.83	Professional	26	$19.09	$30.32	$54.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $60.49 / $90.57 / $185.87	Professional	TC	$60.49	$90.57	$185.87
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $28.97 / $28.97 / $28.97	Facility	26	$28.97	$28.97	$28.97
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $80.65 / $113.08 / $150.78	Professional		$80.65	$113.08	$150.78
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $19.27 / $30.70 / $38.02	Professional	26	$19.27	$30.70	$38.02
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $57.85 / $81.56 / $112.51	Professional	TC	$57.85	$81.56	$112.51
Molina Facility/Professional Professional Modifier Low / Median / High Price $35.81 / $110.28 / $190.97	Professional		$35.81	$110.28	$190.97
United Facility/Professional Professional Modifier Low / Median / High Price $79.98 / $99.32 / $205.75	Professional		$79.98	$99.32	$205.75
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.96 / $23.66 / $48.52	Professional	26	$20.96	$23.66	$48.52
United Facility/Professional Professional Modifier TC Low / Median / High Price $58.05 / $76.05 / $157.12	Professional	TC	$58.05	$76.05	$157.12
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $59.36 / $59.36 / $59.36	Professional		$59.36	$59.36	$59.36
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $11.87 / $11.87 / $11.87	Professional	26	$11.87	$11.87	$11.87
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $47.48 / $47.48 / $47.48	Professional	TC	$47.48	$47.48	$47.48