Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $129.69 / $129.69 / $129.69	Facility	26	$129.69	$129.69	$129.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $245.54 / $346.74 / $457.91	Professional		$245.54	$346.74	$457.91
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.25 / $36.20 / $50.31	Professional	26	$30.25	$36.20	$50.31
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $215.05 / $309.41 / $404.30	Professional	TC	$215.05	$309.41	$404.30
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $251.26 / $251.26 / $251.26	Professional		$251.26	$251.26	$251.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $200.68 / $364.24 / $709.89	Professional		$200.68	$364.24	$709.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $40.59 / $77.19	Professional	26	$23.99	$40.59	$77.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $177.19 / $313.25 / $635.45	Professional	TC	$177.19	$313.25	$635.45
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $216.34 / $386.33 / $718.59	Professional		$216.34	$386.33	$718.59
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $33.71 / $49.26 / $67.73	Professional	26	$33.71	$49.26	$67.73
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $247.10 / $347.38 / $629.35	Professional	TC	$247.10	$347.38	$629.35
Molina Facility/Professional Professional Modifier Low / Median / High Price $41.53 / $399.46 / $546.90	Professional		$41.53	$399.46	$546.90
United Facility/Professional Professional Modifier Low / Median / High Price $192.81 / $257.87 / $1,028.42	Professional		$192.81	$257.87	$1,028.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.21 / $31.15 / $126.08	Professional	26	$23.21	$31.15	$126.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $180.99 / $228.39 / $907.44	Professional	TC	$180.99	$228.39	$907.44
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $216.72 / $216.72 / $216.72	Professional		$216.72	$216.72	$216.72
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $20.88 / $20.88 / $20.88	Professional	26	$20.88	$20.88	$20.88
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $195.84 / $195.84 / $195.84	Professional	TC	$195.84	$195.84	$195.84