Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $59.00 / $192.21	Facility	26	$51.29	$59.00	$192.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $139.15 / $175.15 / $300.00	Professional		$139.15	$175.15	$300.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.22 / $56.97 / $120.08	Professional	26	$50.22	$56.97	$120.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $82.18 / $119.70 / $220.00	Professional	TC	$82.18	$119.70	$220.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $82.57 / $94.88 / $134.69	Professional		$82.57	$94.88	$134.69
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $42.52 / $73.04 / $115.88	Professional	26	$42.52	$73.04	$115.88
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.44 / $64.44 / $173.57	Facility	26	$64.44	$64.44	$173.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $100.82 / $193.89 / $401.91	Professional		$100.82	$193.89	$401.91
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.88 / $62.04 / $120.03	Professional	26	$39.88	$62.04	$120.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $60.86 / $133.00 / $286.41	Professional	TC	$60.86	$133.00	$286.41
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $63.24 / $63.24 / $63.24	Facility	26	$63.24	$63.24	$63.24
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $109.35 / $177.69 / $290.66	Professional		$109.35	$177.69	$290.66
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $44.27 / $65.61 / $83.00	Professional	26	$44.27	$65.61	$83.00
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $67.40 / $108.08 / $212.91	Professional	TC	$67.40	$108.08	$212.91
Molina Facility/Professional Professional Modifier Low / Median / High Price $39.74 / $86.37 / $172.54	Professional		$39.74	$86.37	$172.54
United Facility/Professional Professional Modifier Low / Median / High Price $115.73 / $173.07 / $349.58	Professional		$115.73	$173.07	$349.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.16 / $51.27 / $104.05	Professional	26	$44.16	$51.27	$104.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $68.69 / $98.74 / $216.81	Professional	TC	$68.69	$98.74	$216.81
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $89.78 / $89.78 / $89.78	Professional		$89.78	$89.78	$89.78
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $35.70 / $35.70 / $35.70	Professional	26	$35.70	$35.70	$35.70
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $54.08 / $54.08 / $54.08	Professional	TC	$54.08	$54.08	$54.08