Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.50 / $83.49 / $245.09	Facility	26	$62.50	$83.49	$245.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $250.00 / $375.00 / $525.00	Professional		$250.00	$375.00	$525.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.50 / $89.86 / $143.57	Professional	26	$62.50	$89.86	$143.57
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $187.50 / $250.17 / $369.35	Professional	TC	$187.50	$250.17	$369.35
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $154.63 / $181.92 / $269.02	Professional		$154.63	$181.92	$269.02
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $148.77 / $148.77 / $148.77	Professional	26	$148.77	$148.77	$148.77
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.91 / $79.91 / $213.16	Facility	26	$79.91	$79.91	$213.16
Cigna Facility/Professional Professional Modifier Low / Median / High Price $198.90 / $376.36 / $766.00	Professional		$198.90	$376.36	$766.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.46 / $86.42 / $145.16	Professional	26	$49.46	$86.42	$145.16
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $148.02 / $290.70 / $616.15	Professional	TC	$148.02	$290.70	$616.15
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $77.94 / $77.94 / $77.94	Facility	26	$77.94	$77.94	$77.94
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $233.97 / $370.22 / $534.87	Professional		$233.97	$370.22	$534.87
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $53.58 / $81.09 / $104.47	Professional	26	$53.58	$81.09	$104.47
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $179.40 / $297.93 / $448.50	Professional	TC	$179.40	$297.93	$448.50
Molina Facility/Professional Professional Modifier Low / Median / High Price $62.75 / $192.87 / $335.70	Professional		$62.75	$192.87	$335.70
United Facility/Professional Professional Modifier Low / Median / High Price $238.34 / $327.12 / $644.40	Professional		$238.34	$327.12	$644.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.24 / $62.64 / $136.16	Professional	26	$54.24	$62.64	$136.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $179.98 / $261.22 / $553.38	Professional	TC	$179.98	$261.22	$553.38
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $187.43 / $187.43 / $187.43	Professional		$187.43	$187.43	$187.43
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $47.60 / $47.60 / $47.60	Professional	26	$47.60	$47.60	$47.60
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $139.82 / $139.82 / $139.82	Professional	TC	$139.82	$139.82	$139.82