Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.30 / $73.27 / $269.64	Facility	26	$51.30	$73.27	$269.64
Aetna Facility/Professional Professional Modifier Low / Median / High Price $171.00 / $275.00 / $437.32	Professional		$171.00	$275.00	$437.32
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.30 / $68.14 / $116.31	Professional	26	$51.30	$68.14	$116.31
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $119.70 / $181.95 / $316.61	Professional	TC	$119.70	$181.95	$316.61
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $133.76 / $167.20 / $223.53	Professional		$133.76	$167.20	$223.53
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $56.01 / $99.04 / $158.61	Professional	26	$56.01	$99.04	$158.61
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $87.25 / $87.25 / $235.62	Facility	26	$87.25	$87.25	$235.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $157.37 / $305.13 / $594.00	Professional		$157.37	$305.13	$594.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.11 / $78.48 / $154.43	Professional	26	$54.11	$78.48	$154.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $109.87 / $221.35 / $447.34	Professional	TC	$109.87	$221.35	$447.34
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $76.87 / $76.87 / $76.87	Facility	26	$76.87	$76.87	$76.87
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $198.39 / $307.68 / $402.24	Professional		$198.39	$307.68	$402.24
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $55.08 / $80.72 / $100.89	Professional	26	$55.08	$80.72	$100.89
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $135.65 / $228.63 / $310.36	Professional	TC	$135.65	$228.63	$310.36
Molina Facility/Professional Professional Modifier Low / Median / High Price $89.06 / $150.76 / $290.58	Professional		$89.06	$150.76	$290.58
United Facility/Professional Professional Modifier Low / Median / High Price $192.01 / $268.88 / $497.32	Professional		$192.01	$268.88	$497.32
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.40 / $68.95 / $136.07	Professional	26	$54.40	$68.95	$136.07
United Facility/Professional Professional Modifier TC Low / Median / High Price $125.22 / $197.50 / $381.47	Professional	TC	$125.22	$197.50	$381.47
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $146.30 / $146.30 / $146.30	Professional		$146.30	$146.30	$146.30
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $48.62 / $48.62 / $48.62	Professional	26	$48.62	$48.62	$48.62
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $97.68 / $97.68 / $97.68	Professional	TC	$97.68	$97.68	$97.68