Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.66 / $107.15 / $870.96	Facility	26	$61.66	$107.15	$870.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $436.52 / $870.96	Professional		$251.19	$436.52	$870.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $117.49 / $257.04	Professional	26	$63.10	$117.49	$257.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $338.84 / $616.60	Professional	TC	$186.21	$338.84	$616.60
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $575.44 / $575.44	Professional		$575.44	$575.44	$575.44
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $112.20 / $138.04	Professional	26	$112.20	$112.20	$138.04
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 $251.19 / $446.68 / $933.25	Professional		$251.19	$446.68	$933.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $104.71 / $190.55	Professional	26	$60.26	$104.71	$190.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $346.74 / $741.31	Professional	TC	$199.53	$346.74	$741.31
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 $239.88 / $416.87 / $602.56	Professional		$239.88	$416.87	$602.56
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 $181.97 / $323.59 / $478.63	Professional	TC	$181.97	$323.59	$478.63
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $158.49 / $446.68	Professional		$32.36	$158.49	$446.68
United Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $407.38 / $758.58	Professional		$295.12	$407.38	$758.58
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 $229.09 / $323.59 / $602.56	Professional	TC	$229.09	$323.59	$602.56
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $263.03 / $323.59	Professional		$263.03	$263.03	$323.59
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 $199.53 / $199.53 / $245.47	Professional	TC	$199.53	$199.53	$245.47