Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.50 / $77.11 / $242.77	Facility	26	$62.50	$77.11	$242.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $250.00 / $402.08 / $602.44	Professional		$250.00	$402.08	$602.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.50 / $93.75 / $155.65	Professional	26	$62.50	$93.75	$155.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $187.50 / $287.13 / $438.83	Professional	TC	$187.50	$287.13	$438.83
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $201.20 / $218.88 / $662.87	Professional		$201.20	$218.88	$662.87
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.43 / $89.99 / $111.38	Professional	26	$52.43	$89.99	$111.38
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.09 / $79.09 / $212.11	Facility	26	$79.09	$79.09	$212.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $251.88 / $463.14 / $899.22	Professional		$251.88	$463.14	$899.22
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.20 / $85.00 / $144.47	Professional	26	$49.20	$85.00	$144.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $203.62 / $379.76 / $777.47	Professional	TC	$203.62	$379.76	$777.47
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $77.23 / $77.23 / $77.23	Facility	26	$77.23	$77.23	$77.23
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $301.69 / $457.93 / $619.54	Professional		$301.69	$457.93	$619.54
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $49.35 / $75.34 / $103.53	Professional	26	$49.35	$75.34	$103.53
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $247.63 / $380.29 / $508.53	Professional	TC	$247.63	$380.29	$508.53
Molina Facility/Professional Professional Modifier Low / Median / High Price $62.75 / $230.89 / $413.38	Professional		$62.75	$230.89	$413.38
United Facility/Professional Professional Modifier Low / Median / High Price $304.02 / $404.27 / $779.95	Professional		$304.02	$404.27	$779.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.03 / $62.67 / $132.28	Professional	26	$54.03	$62.67	$132.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $248.25 / $345.00 / $671.52	Professional	TC	$248.25	$345.00	$671.52
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $201.83 / $201.83 / $201.83	Professional		$201.83	$201.83	$201.83
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $39.67 / $39.67 / $39.67	Professional	26	$39.67	$39.67	$39.67
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $162.16 / $162.16 / $162.16	Professional	TC	$162.16	$162.16	$162.16