Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.94 / $53.53 / $220.84	Facility	26	$42.94	$53.53	$220.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $216.22 / $249.48 / $415.80	Professional		$216.22	$249.48	$415.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.94 / $49.54 / $86.12	Professional	26	$42.94	$49.54	$86.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $173.28 / $199.27 / $333.24	Professional	TC	$173.28	$199.27	$333.24
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $181.23 / $226.53 / $238.75	Professional		$181.23	$226.53	$238.75
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $48.66 / $82.12 / $99.71	Professional	26	$48.66	$82.12	$99.71
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $73.06 / $73.06 / $73.06	Facility	26	$73.06	$73.06	$73.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $213.65 / $374.35 / $580.58	Professional		$213.65	$374.35	$580.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.59 / $79.28 / $116.01	Professional	26	$44.59	$79.28	$116.01
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $169.06 / $314.13 / $487.54	Professional	TC	$169.06	$314.13	$487.54
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $198.22 / $223.83 / $456.36	Professional		$198.22	$223.83	$456.36
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $42.58 / $48.66 / $92.57	Professional	26	$42.58	$48.66	$92.57
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $155.63 / $177.25 / $368.20	Professional	TC	$155.63	$177.25	$368.20
Molina Facility/Professional Professional Modifier Low / Median / High Price $41.79 / $255.79 / $446.78	Professional		$41.79	$255.79	$446.78
United Facility/Professional Professional Modifier Low / Median / High Price $259.41 / $338.65 / $624.96	Professional		$259.41	$338.65	$624.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.53 / $68.56 / $128.11	Professional	26	$50.53	$68.56	$128.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $210.15 / $263.97 / $486.67	Professional	TC	$210.15	$263.97	$486.67
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $184.54 / $184.54 / $184.54	Professional		$184.54	$184.54	$184.54
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $37.14 / $37.14 / $37.14	Professional	26	$37.14	$37.14	$37.14
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $147.38 / $147.38 / $147.38	Professional	TC	$147.38	$147.38	$147.38