Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.86 / $48.98 / $52.48	Facility	26	$47.86	$48.98	$52.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $141.25 / $436.52	Professional		$107.15	$141.25	$436.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $66.07 / $169.82	Professional	26	$52.48	$66.07	$169.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $64.57 / $169.82	Professional	TC	$50.12	$64.57	$169.82
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $109.65 / $173.78	Professional		$95.50	$109.65	$173.78
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $46.77 / $60.26	Professional	26	$46.77	$46.77	$60.26
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.45 / $67.61 / $114.82	Facility	26	$14.45	$67.61	$114.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $169.82 / $316.23	Professional		$100.00	$169.82	$316.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $79.43 / $144.54	Professional	26	$53.70	$79.43	$144.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $97.72 / $186.21	Professional	TC	$53.70	$97.72	$186.21
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $64.57 / $64.57 / $64.57	Facility	26	$64.57	$64.57	$64.57
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $138.04 / $218.78	Professional		$83.18	$138.04	$218.78
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $57.54 / $89.13	Professional	26	$41.69	$57.54	$89.13
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $69.18 / $138.04	Professional	TC	$43.65	$69.18	$138.04
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $58.88 / $125.89	Professional		$32.36	$58.88	$125.89
United Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $154.88 / $257.04	Professional		$100.00	$154.88	$257.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $66.07 / $114.82	Professional	26	$47.86	$66.07	$114.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $83.18 / $158.49	Professional	TC	$47.86	$83.18	$158.49
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $89.13 / $117.49	Professional		$89.13	$89.13	$117.49
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $44.67 / $58.88	Professional	26	$44.67	$44.67	$58.88
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $44.67 / $58.88	Professional	TC	$44.67	$44.67	$58.88