Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $70.79 / $295.12	Facility	26	$51.29	$70.79	$295.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $302.00 / $707.95	Professional		$169.82	$302.00	$707.95
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $95.50 / $251.19	Professional	26	$51.29	$95.50	$251.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $218.78 / $416.87	Professional	TC	$120.23	$218.78	$416.87
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $257.04 / $575.44	Professional		$173.78	$257.04	$575.44
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $89.13 / $158.49	Professional	26	$63.10	$89.13	$158.49
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $97.72 / $169.82	Facility	26	$20.89	$97.72	$169.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $371.54 / $812.83	Professional		$218.78	$371.54	$812.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $91.20 / $181.97	Professional	26	$60.26	$91.20	$181.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $275.42 / $645.65	Professional	TC	$165.96	$275.42	$645.65
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 $213.80 / $331.13 / $457.09	Professional		$213.80	$331.13	$457.09
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $83.18 / $125.89	Professional	26	$58.88	$83.18	$125.89
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $245.47 / $354.81	Professional	TC	$154.88	$245.47	$354.81
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $128.82 / $354.81	Professional		$32.36	$128.82	$354.81
United Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $363.08 / $660.69	Professional		$245.47	$363.08	$660.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $81.28 / $151.36	Professional	26	$69.18	$81.28	$151.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $269.15 / $489.78	Professional	TC	$173.78	$269.15	$489.78
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $199.53 / $257.04	Professional		$199.53	$199.53	$257.04
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $54.95 / $83.18	Professional	26	$54.95	$54.95	$83.18
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $147.91 / $169.82	Professional	TC	$147.91	$147.91	$169.82