Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $66.87 / $67.59 / $79.34	Facility	26	$66.87	$67.59	$79.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $197.12 / $252.36 / $469.49	Professional		$197.12	$252.36	$469.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.59 / $87.71 / $215.55	Professional	26	$67.59	$87.71	$215.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $117.99 / $157.60 / $261.02	Professional	TC	$117.99	$157.60	$261.02
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $199.13 / $246.91 / $346.32	Professional		$199.13	$246.91	$346.32
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $89.37 / $105.07 / $127.57	Professional	26	$89.37	$105.07	$127.57
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.46 / $93.46 / $245.52	Facility	26	$93.46	$93.46	$245.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $199.80 / $327.45 / $565.01	Professional		$199.80	$327.45	$565.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.59 / $119.95 / $211.34	Professional	26	$77.59	$119.95	$211.34
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $136.47 / $207.61 / $353.32	Professional	TC	$136.47	$207.61	$353.32
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $88.94 / $88.94 / $88.94	Facility	26	$88.94	$88.94	$88.94
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $149.88 / $258.10 / $355.70	Professional		$149.88	$258.10	$355.70
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $54.48 / $88.94 / $116.74	Professional	26	$54.48	$88.94	$116.74
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $95.40 / $168.70 / $250.40	Professional	TC	$95.40	$168.70	$250.40
Molina Facility/Professional Professional Modifier Low / Median / High Price $96.94 / $159.45 / $303.28	Professional		$96.94	$159.45	$303.28
United Facility/Professional Professional Modifier Low / Median / High Price $189.25 / $273.35 / $458.83	Professional		$189.25	$273.35	$458.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.06 / $103.59 / $172.31	Professional	26	$69.06	$103.59	$172.31
United Facility/Professional Professional Modifier TC Low / Median / High Price $119.92 / $173.06 / $290.97	Professional	TC	$119.92	$173.06	$290.97
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $175.66 / $175.66 / $175.66	Professional		$175.66	$175.66	$175.66
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $61.79 / $61.79 / $61.79	Professional	26	$61.79	$61.79	$61.79
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $113.87 / $113.87 / $144.97	Professional	TC	$113.87	$113.87	$144.97