Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $93.33 / $93.33	Facility	26	$89.13	$93.33	$93.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $380.19 / $691.83	Professional		$263.03	$380.19	$691.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $112.20 / $199.53	Professional	26	$93.33	$112.20	$199.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $257.04 / $467.74	Professional	TC	$169.82	$257.04	$467.74
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $416.87 / $562.34	Professional		$416.87	$416.87	$562.34
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $131.83 / $131.83	Professional	26	$131.83	$131.83	$131.83
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.92 / $125.89 / $177.83	Facility	26	$26.92	$125.89	$177.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $436.52 / $794.33	Professional		$302.00	$436.52	$794.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $147.91 / $257.04	Professional	26	$91.20	$147.91	$257.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $288.40 / $549.54	Professional	TC	$199.53	$288.40	$549.54
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $239.88 / $309.03	Professional		$229.09	$239.88	$309.03
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $81.28 / $120.23	Professional	26	$75.86	$81.28	$120.23
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $158.49 / $204.17	Professional	TC	$151.36	$158.49	$204.17
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $407.38	Professional		$32.36	$33.11	$407.38
United Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $389.05 / $660.69	Professional		$257.04	$389.05	$660.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $131.83 / $223.87	Professional	26	$89.13	$131.83	$223.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $251.19 / $457.09	Professional	TC	$162.18	$251.19	$457.09
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $263.03 / $323.59	Professional		$263.03	$263.03	$323.59
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $79.43 / $107.15	Professional	26	$79.43	$79.43	$107.15
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $181.97 / $213.80	Professional	TC	$181.97	$181.97	$213.80