Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.66 / $93.33 / $309.03	Facility	26	$61.66	$93.33	$309.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $416.87 / $851.14	Professional		$251.19	$416.87	$851.14
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $123.03 / $251.19	Professional	26	$63.10	$123.03	$251.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $288.40 / $602.56	Professional	TC	$186.21	$288.40	$602.56
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $190.55 / $213.80	Professional		$190.55	$190.55	$213.80
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $81.28 / $147.91	Professional	26	$63.10	$81.28	$147.91
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $97.72 / $165.96	Facility	26	$20.89	$97.72	$165.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $398.11 / $891.25	Professional		$204.17	$398.11	$891.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $107.15 / $190.55	Professional	26	$60.26	$107.15	$190.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $281.84 / $707.95	Professional	TC	$151.36	$281.84	$707.95
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $95.50 / $95.50 / $95.50	Facility	26	$95.50	$95.50	$95.50
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $363.08 / $588.84	Professional		$194.98	$363.08	$588.84
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $89.13 / $128.82	Professional	26	$58.88	$89.13	$128.82
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $251.19 / $478.63	Professional	TC	$134.90	$251.19	$478.63
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $134.90 / $346.74	Professional		$32.36	$134.90	$346.74
United Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $371.54 / $741.31	Professional		$245.47	$371.54	$741.31
United Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $79.43 / $154.88	Professional	26	$67.61	$79.43	$154.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $263.03 / $562.34	Professional	TC	$173.78	$263.03	$562.34
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $213.80 / $269.15	Professional		$213.80	$213.80	$269.15
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $64.57 / $83.18	Professional	26	$64.57	$64.57	$83.18
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $147.91 / $181.97	Professional	TC	$147.91	$147.91	$181.97