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 / $831.76	Professional		$251.19	$416.87	$831.76
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $117.49 / $269.15	Professional	26	$63.10	$117.49	$269.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $281.84 / $562.34	Professional	TC	$186.21	$281.84	$562.34
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $199.53 / $588.84	Professional		$199.53	$199.53	$588.84
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $83.18 / $134.90	Professional	26	$63.10	$83.18	$134.90
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $134.90 / $134.90	Professional	TC	$134.90	$134.90	$134.90
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 / $870.96	Professional		$204.17	$398.11	$870.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $104.71 / $177.83	Professional	26	$60.26	$104.71	$177.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $281.84 / $691.83	Professional	TC	$147.91	$281.84	$691.83
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 / $354.81 / $588.84	Professional		$194.98	$354.81	$588.84
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $89.13 / $128.82	Professional	26	$57.54	$89.13	$128.82
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $245.47 / $467.74	Professional	TC	$134.90	$245.47	$467.74
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $131.83 / $338.84	Professional		$32.36	$131.83	$338.84
United Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $371.54 / $724.44	Professional		$245.47	$371.54	$724.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $77.62 / $154.88	Professional	26	$66.07	$77.62	$154.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $257.04 / $549.54	Professional	TC	$169.82	$257.04	$549.54
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $208.93 / $263.03	Professional		$208.93	$208.93	$263.03
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $64.57 / $81.28	Professional	26	$64.57	$64.57	$81.28
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $144.54 / $177.83	Professional	TC	$144.54	$144.54	$177.83