Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.75 / $62.50 / $198.16	Facility	26	$47.75	$62.50	$198.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $240.91 / $331.70 / $525.00	Professional		$240.91	$331.70	$525.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.65 / $72.97 / $140.00	Professional	26	$57.65	$72.97	$140.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $181.15 / $249.63 / $369.35	Professional	TC	$181.15	$249.63	$369.35
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $171.15 / $171.15 / $171.15	Professional		$171.15	$171.15	$171.15
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $41.94 / $88.94 / $116.57	Professional	26	$41.94	$88.94	$116.57
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.84 / $64.84 / $174.56	Facility	26	$64.84	$64.84	$174.56
Cigna Facility/Professional Professional Modifier Low / Median / High Price $170.22 / $395.16 / $756.28	Professional		$170.22	$395.16	$756.28
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.11 / $69.92 / $127.50	Professional	26	$40.11	$69.92	$127.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $129.63 / $312.20 / $651.62	Professional	TC	$129.63	$312.20	$651.62
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $63.60 / $63.60 / $63.60	Facility	26	$63.60	$63.60	$63.60
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $253.58 / $435.62 / $584.45	Professional		$253.58	$435.62	$584.45
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $44.52 / $67.00 / $88.64	Professional	26	$44.52	$67.00	$88.64
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $211.26 / $366.88 / $498.79	Professional	TC	$211.26	$366.88	$498.79
Molina Facility/Professional Professional Modifier Low / Median / High Price $41.36 / $191.96 / $327.34	Professional		$41.36	$191.96	$327.34
United Facility/Professional Professional Modifier Low / Median / High Price $199.83 / $325.26 / $651.50	Professional		$199.83	$325.26	$651.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.53 / $50.59 / $107.98	Professional	26	$43.53	$50.59	$107.98
United Facility/Professional Professional Modifier TC Low / Median / High Price $150.75 / $258.51 / $580.24	Professional	TC	$150.75	$258.51	$580.24
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $176.27 / $176.27 / $176.27	Professional		$176.27	$176.27	$176.27
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $42.24 / $42.24 / $42.24	Professional	26	$42.24	$42.24	$42.24
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $134.03 / $134.03 / $134.03	Professional	TC	$134.03	$134.03	$134.03