Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.62 / $32.47 / $125.72	Facility	26	$25.62	$32.47	$125.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $79.83 / $110.51 / $211.82	Professional		$79.83	$110.51	$211.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.62 / $34.11 / $96.75	Professional	26	$25.62	$34.11	$96.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $54.21 / $76.27 / $123.18	Professional	TC	$54.21	$76.27	$123.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $62.99 / $89.98 / $286.80	Professional		$62.99	$89.98	$286.80
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.11 / $49.82 / $79.09	Professional	26	$28.11	$49.82	$79.09
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.57 / $43.57 / $101.01	Facility	26	$43.57	$43.57	$101.01
Cigna Facility/Professional Professional Modifier Low / Median / High Price $80.20 / $116.52 / $224.31	Professional		$80.20	$116.52	$224.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.36 / $39.10 / $74.92	Professional	26	$26.36	$39.10	$74.92
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $57.39 / $79.75 / $153.75	Professional	TC	$57.39	$79.75	$153.75
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $36.81 / $36.81 / $36.81	Facility	26	$36.81	$36.81	$36.81
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $78.73 / $111.73 / $153.97	Professional		$78.73	$111.73	$153.97
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $26.46 / $38.86 / $48.85	Professional	26	$26.46	$38.86	$48.85
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $52.90 / $75.48 / $105.67	Professional	TC	$52.90	$75.48	$105.67
Molina Facility/Professional Professional Modifier Low / Median / High Price $35.97 / $83.35 / $170.72	Professional		$35.97	$83.35	$170.72
United Facility/Professional Professional Modifier Low / Median / High Price $80.68 / $99.74 / $208.16	Professional		$80.68	$99.74	$208.16
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.80 / $34.45 / $72.81	Professional	26	$26.80	$34.45	$72.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $54.11 / $66.83 / $141.16	Professional	TC	$54.11	$66.83	$141.16
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $66.92 / $66.92 / $66.92	Professional		$66.92	$66.92	$66.92
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $20.55 / $20.55 / $20.55	Professional	26	$20.55	$20.55	$20.55
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $46.37 / $46.37 / $46.37	Professional	TC	$46.37	$46.37	$46.37