Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.40 / $45.14 / $130.19	Facility	26	$27.40	$45.14	$130.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $72.66 / $103.15 / $243.47	Professional		$72.66	$103.15	$243.47
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.40 / $37.86 / $90.14	Professional	26	$27.40	$37.86	$90.14
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $45.26 / $61.80 / $105.04	Professional	TC	$45.26	$61.80	$105.04
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $75.73 / $100.98 / $165.52	Professional		$75.73	$100.98	$165.52
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.12 / $46.18 / $70.53	Professional	26	$30.12	$46.18	$70.53
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $53.13 / $60.49 / $79.72	Professional	TC	$53.13	$60.49	$79.72
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.25 / $46.25 / $128.35	Facility	26	$46.25	$46.25	$128.35
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.93 / $107.05 / $220.77	Professional		$74.93	$107.05	$220.77
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.21 / $44.97 / $89.35	Professional	26	$28.21	$44.97	$89.35
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $46.72 / $67.48 / $138.13	Professional	TC	$46.72	$67.48	$138.13
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $47.38 / $47.38 / $47.38	Facility	26	$47.38	$47.38	$47.38
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $69.95 / $104.35 / $155.13	Professional		$69.95	$104.35	$155.13
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $26.93 / $39.92 / $60.11	Professional	26	$26.93	$39.92	$60.11
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $42.00 / $65.05 / $95.88	Professional	TC	$42.00	$65.05	$95.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $36.60 / $82.75 / $142.84	Professional		$36.60	$82.75	$142.84
United Facility/Professional Professional Modifier Low / Median / High Price $81.63 / $93.46 / $175.62	Professional		$81.63	$93.46	$175.62
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.35 / $36.04 / $67.55	Professional	26	$32.35	$36.04	$67.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $49.82 / $58.39 / $114.91	Professional	TC	$49.82	$58.39	$114.91
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $69.68 / $69.68 / $69.68	Professional		$69.68	$69.68	$69.68
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $25.34 / $25.34 / $25.34	Professional	26	$25.34	$25.34	$25.34
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $44.35 / $44.35 / $44.35	Professional	TC	$44.35	$44.35	$44.35