Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $115.39 / $115.39 / $115.39	Facility	26	$115.39	$115.39	$115.39
Aetna Facility/Professional Professional Modifier Low / Median / High Price $128.65 / $219.14 / $310.48	Professional		$128.65	$219.14	$310.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.27 / $38.82 / $105.08	Professional	26	$26.27	$38.82	$105.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $99.88 / $190.88 / $335.28	Professional	TC	$99.88	$190.88	$335.28
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $193.73 / $193.73 / $193.73	Professional		$193.73	$193.73	$193.73
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $13.00 / $19.38 / $46.64	Professional	26	$13.00	$19.38	$46.64
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $164.57 / $164.57 / $164.57	Professional	TC	$164.57	$164.57	$164.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $105.07 / $214.08 / $462.78	Professional		$105.07	$214.08	$462.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.14 / $36.54 / $68.25	Professional	26	$21.14	$36.54	$68.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $82.25 / $175.13 / $401.59	Professional	TC	$82.25	$175.13	$401.59
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $121.96 / $217.78 / $338.43	Professional		$121.96	$217.78	$338.43
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $26.54 / $46.29 / $58.15	Professional	26	$26.54	$46.29	$58.15
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $95.42 / $170.39 / $261.98	Professional	TC	$95.42	$170.39	$261.98
Molina Facility/Professional Professional Modifier Low / Median / High Price $41.53 / $259.32 / $353.27	Professional		$41.53	$259.32	$353.27
United Facility/Professional Professional Modifier Low / Median / High Price $113.93 / $198.96 / $696.52	Professional		$113.93	$198.96	$696.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.96 / $27.82 / $109.61	Professional	26	$20.96	$27.82	$109.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $88.24 / $171.56 / $604.14	Professional	TC	$88.24	$171.56	$604.14
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $93.86 / $208.57 / $208.57	Professional		$93.86	$208.57	$208.57
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $13.90 / $30.89 / $30.89	Professional	26	$13.90	$30.89	$30.89
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $79.95 / $177.68 / $177.68	Professional	TC	$79.95	$177.68	$177.68