Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $20.42 / $21.88	Facility	26	$19.95	$20.42	$21.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $151.36 / $354.81	Professional		$109.65	$151.36	$354.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $28.18 / $69.18	Professional	26	$20.42	$28.18	$69.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $112.20 / $251.19	Professional	TC	$87.10	$112.20	$251.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $95.50 / $169.82	Professional		$83.18	$95.50	$169.82
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $37.15 / $43.65	Professional	26	$18.20	$37.15	$43.65
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $5.62 / $26.30 / $45.71	Facility	26	$5.62	$26.30	$45.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $169.82 / $309.03	Professional		$102.33	$169.82	$309.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $29.51 / $58.88	Professional	26	$20.42	$29.51	$58.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $151.36 / $275.42	Professional	TC	$93.33	$151.36	$275.42
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $27.54 / $27.54 / $27.54	Facility	26	$27.54	$27.54	$27.54
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $128.82 / $190.55	Professional		$85.11	$128.82	$190.55
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $23.44 / $37.15	Professional	26	$16.98	$23.44	$37.15
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $104.71 / $151.36	Professional	TC	$67.61	$104.71	$151.36
Molina Facility/Professional Professional Modifier Low / Median / High Price $20.89 / $75.86 / $141.25	Professional		$20.89	$75.86	$141.25
United Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $151.36 / $257.04	Professional		$102.33	$151.36	$257.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $25.70 / $45.71	Professional	26	$17.78	$25.70	$45.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $125.89 / $208.93	Professional	TC	$81.28	$125.89	$208.93
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $93.33 / $120.23	Professional		$93.33	$93.33	$120.23
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $17.78 / $23.99	Professional	26	$17.78	$17.78	$23.99
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $75.86 / $95.50	Professional	TC	$75.86	$75.86	$95.50