Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $67.61 / $218.78	Facility	26	$51.29	$67.61	$218.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $275.42 / $549.54	Professional		$169.82	$275.42	$549.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $67.61 / $162.18	Professional	26	$51.29	$67.61	$162.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $194.98 / $389.05	Professional	TC	$120.23	$194.98	$389.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $190.55 / $446.68	Professional		$141.25	$190.55	$446.68
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $87.10 / $125.89	Professional	26	$45.71	$87.10	$125.89
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.45 / $67.61 / $117.49	Facility	26	$14.45	$67.61	$117.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $309.03 / $645.65	Professional		$158.49	$309.03	$645.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $74.13 / $141.25	Professional	26	$42.66	$74.13	$141.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $234.42 / $501.19	Professional	TC	$123.03	$234.42	$501.19
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $75.86 / $75.86 / $75.86	Facility	26	$75.86	$75.86	$75.86
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $295.12 / $426.58	Professional		$147.91	$295.12	$426.58
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $69.18 / $102.33	Professional	26	$40.74	$69.18	$102.33
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $223.87 / $331.13	Professional	TC	$107.15	$223.87	$331.13
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $97.72 / $269.15	Professional		$32.36	$97.72	$269.15
United Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $281.84 / $501.19	Professional		$194.98	$281.84	$501.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $60.26 / $112.20	Professional	26	$50.12	$60.26	$112.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $213.80 / $389.05	Professional	TC	$141.25	$213.80	$389.05
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $162.18 / $204.17	Professional		$162.18	$162.18	$204.17
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $45.71 / $57.54	Professional	26	$45.71	$45.71	$57.54
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $117.49 / $144.54	Professional	TC	$117.49	$117.49	$144.54