Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.70 / $20.34 / $21.75	Facility	26	$19.70	$20.34	$21.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $136.46 / $174.30 / $310.51	Professional		$136.46	$174.30	$310.51
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.49 / $23.42 / $40.15	Professional	26	$20.49	$23.42	$40.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $115.97 / $148.07 / $255.28	Professional	TC	$115.97	$148.07	$255.28
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $117.90 / $124.81 / $241.55	Professional		$117.90	$124.81	$241.55
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $17.12 / $17.82 / $31.20	Professional	26	$17.12	$17.82	$31.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.06 / $27.06 / $72.37	Facility	26	$27.06	$27.06	$72.37
Cigna Facility/Professional Professional Modifier Low / Median / High Price $136.44 / $220.66 / $394.18	Professional		$136.44	$220.66	$394.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.02 / $33.38 / $57.73	Professional	26	$22.02	$33.38	$57.73
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $122.54 / $198.52 / $343.69	Professional	TC	$122.54	$198.52	$343.69
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $26.96 / $26.96 / $26.96	Facility	26	$26.96	$26.96	$26.96
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $103.16 / $168.33 / $246.62	Professional		$103.16	$168.33	$246.62
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $16.17 / $27.97 / $36.07	Professional	26	$16.17	$27.97	$36.07
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $86.98 / $137.33 / $208.22	Professional	TC	$86.98	$137.33	$208.22
Molina Facility/Professional Professional Modifier Low / Median / High Price $36.17 / $155.70 / $247.83	Professional		$36.17	$155.70	$247.83
United Facility/Professional Professional Modifier Low / Median / High Price $131.07 / $204.60 / $346.21	Professional		$131.07	$204.60	$346.21
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.98 / $28.34 / $50.20	Professional	26	$19.98	$28.34	$50.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $111.47 / $173.10 / $296.12	Professional	TC	$111.47	$173.10	$296.12
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $121.79 / $121.79 / $121.79	Professional		$121.79	$121.79	$121.79
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $17.87 / $17.87 / $17.87	Professional	26	$17.87	$17.87	$17.87
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $103.92 / $103.92 / $132.13	Professional	TC	$103.92	$103.92	$132.13