Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $52.48 / $204.17	Facility	26	$51.29	$52.48	$204.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $257.04 / $602.56	Professional		$169.82	$257.04	$602.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $77.62 / $194.98	Professional	26	$51.29	$77.62	$194.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $158.49 / $331.13	Professional	TC	$114.82	$158.49	$331.13
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $131.83 / $288.40	Professional		$104.71	$131.83	$288.40
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $70.79 / $102.33	Professional	26	$44.67	$70.79	$102.33
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $69.18 / $117.49	Facility	26	$14.79	$69.18	$117.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $245.47 / $524.81	Professional		$128.82	$245.47	$524.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $70.79 / $131.83	Professional	26	$42.66	$70.79	$131.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $169.82 / $380.19	Professional	TC	$85.11	$169.82	$380.19
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $67.61 / $67.61 / $67.61	Facility	26	$67.61	$67.61	$67.61
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $213.80 / $338.84	Professional		$123.03	$213.80	$338.84
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $61.66 / $89.13	Professional	26	$41.69	$61.66	$89.13
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $141.25 / $251.19	Professional	TC	$81.28	$141.25	$251.19
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $83.18 / $208.93	Professional		$32.36	$83.18	$208.93
United Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $213.80 / $398.11	Professional		$147.91	$213.80	$398.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $54.95 / $107.15	Professional	26	$46.77	$54.95	$107.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $144.54 / $288.40	Professional	TC	$97.72	$144.54	$288.40
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $125.89 / $169.82	Professional		$125.89	$125.89	$169.82
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $42.66 / $58.88	Professional	26	$42.66	$42.66	$58.88
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $83.18 / $109.65	Professional	TC	$83.18	$83.18	$109.65