Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $62.25 / $200.49	Facility	26	$51.29	$62.25	$200.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $171.00 / $246.69 / $397.76	Professional		$171.00	$246.69	$397.76
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.93 / $56.04 / $88.18	Professional	26	$50.93	$56.04	$88.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $119.70 / $174.59 / $337.38	Professional	TC	$119.70	$174.59	$337.38
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $128.91 / $147.34 / $414.38	Professional		$128.91	$147.34	$414.38
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $41.61 / $74.13 / $99.44	Professional	26	$41.61	$74.13	$99.44
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $65.64 / $65.64 / $176.58	Facility	26	$65.64	$65.64	$176.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $142.12 / $317.95 / $604.73	Professional		$142.12	$317.95	$604.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.59 / $65.00 / $124.63	Professional	26	$40.59	$65.00	$124.63
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $103.71 / $253.66 / $489.00	Professional	TC	$103.71	$253.66	$489.00
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 $184.17 / $305.77 / $404.30	Professional		$184.17	$305.77	$404.30
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $45.28 / $66.08 / $84.89	Professional	26	$45.28	$66.08	$84.89
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $129.26 / $239.85 / $325.79	Professional	TC	$129.26	$239.85	$325.79
Molina Facility/Professional Professional Modifier Low / Median / High Price $41.40 / $157.72 / $276.56	Professional		$41.40	$157.72	$276.56
United Facility/Professional Professional Modifier Low / Median / High Price $181.98 / $267.45 / $480.97	Professional		$181.98	$267.45	$480.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.97 / $52.31 / $111.73	Professional	26	$44.97	$52.31	$111.73
United Facility/Professional Professional Modifier TC Low / Median / High Price $132.32 / $208.90 / $396.31	Professional	TC	$132.32	$208.90	$396.31
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $151.13 / $151.13 / $151.13	Professional		$151.13	$151.13	$151.13
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $42.75 / $42.75 / $42.75	Professional	26	$42.75	$42.75	$42.75
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $108.38 / $108.38 / $108.38	Professional	TC	$108.38	$108.38	$108.38