Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.20 / $23.73 / $98.64	Facility	26	$19.20	$23.73	$98.64
Aetna Facility/Professional Professional Modifier Low / Median / High Price $85.33 / $101.97 / $163.50	Professional		$85.33	$101.97	$163.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.20 / $25.27 / $41.50	Professional	26	$19.20	$25.27	$41.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $66.13 / $79.08 / $130.51	Professional	TC	$66.13	$79.08	$130.51
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $86.48 / $260.14 / $260.14	Professional		$86.48	$260.14	$260.14
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $21.82 / $44.21 / $44.21	Professional	26	$21.82	$44.21	$44.21
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.15 / $32.15 / $85.29	Facility	26	$32.15	$32.15	$85.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $76.59 / $114.43 / $229.92	Professional		$76.59	$114.43	$229.92
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.76 / $31.40 / $57.38	Professional	26	$19.76	$31.40	$57.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $58.47 / $87.89 / $177.81	Professional	TC	$58.47	$87.89	$177.81
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $30.69 / $30.69 / $30.69	Facility	26	$30.69	$30.69	$30.69
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $80.65 / $114.04 / $152.52	Professional		$80.65	$114.04	$152.52
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $20.22 / $30.70 / $40.28	Professional	26	$20.22	$30.70	$40.28
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $57.47 / $81.04 / $109.30	Professional	TC	$57.47	$81.04	$109.30
Molina Facility/Professional Professional Modifier Low / Median / High Price $35.83 / $110.28 / $190.97	Professional		$35.83	$110.28	$190.97
United Facility/Professional Professional Modifier Low / Median / High Price $77.20 / $102.12 / $201.74	Professional		$77.20	$102.12	$201.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.13 / $25.96 / $56.70	Professional	26	$21.13	$25.96	$56.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $55.92 / $76.63 / $150.72	Professional	TC	$55.92	$76.63	$150.72
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $64.54 / $64.54 / $64.54	Professional		$64.54	$64.54	$64.54
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $14.01 / $14.01 / $14.01	Professional	26	$14.01	$14.01	$14.01
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $50.53 / $50.53 / $50.53	Professional	TC	$50.53	$50.53	$50.53