Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $306.99 / $306.99 / $306.99	Facility	26	$306.99	$306.99	$306.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $129.78 / $176.10 / $613.71	Professional		$129.78	$176.10	$613.71
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.88 / $90.26 / $144.36	Professional	26	$75.88	$90.26	$144.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $53.90 / $84.49 / $130.38	Professional	TC	$53.90	$84.49	$130.38
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $109.13 / $109.13 / $109.13	Professional		$109.13	$109.13	$109.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $113.90 / $186.05 / $393.71	Professional		$113.90	$186.05	$393.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.09 / $106.30 / $212.31	Professional	26	$61.09	$106.30	$212.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $47.07 / $81.22 / $172.76	Professional	TC	$47.07	$81.22	$172.76
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $206.10 / $266.95 / $526.09	Professional		$206.10	$266.95	$526.09
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $100.84 / $136.13 / $189.83	Professional	26	$100.84	$136.13	$189.83
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $97.83 / $114.50 / $264.37	Professional	TC	$97.83	$114.50	$264.37
Molina Facility/Professional Professional Modifier Low / Median / High Price $112.94 / $166.70 / $287.44	Professional		$112.94	$166.70	$287.44
United Facility/Professional Professional Modifier Low / Median / High Price $109.87 / $163.58 / $586.15	Professional		$109.87	$163.58	$586.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $61.01 / $84.58 / $366.47	Professional	26	$61.01	$84.58	$366.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $48.86 / $83.00 / $223.36	Professional	TC	$48.86	$83.00	$223.36
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $81.34 / $180.75 / $180.75	Professional		$81.34	$180.75	$180.75
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $40.54 / $90.12 / $90.12	Professional	26	$40.54	$90.12	$90.12
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $40.78 / $90.63 / $90.63	Professional	TC	$40.78	$90.63	$90.63