Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.50 / $71.72 / $296.22	Facility	26	$62.50	$71.72	$296.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $250.00 / $423.33 / $638.00	Professional		$250.00	$423.33	$638.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.50 / $106.43 / $174.12	Professional	26	$62.50	$106.43	$174.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $187.50 / $299.00 / $474.22	Professional	TC	$187.50	$299.00	$474.22
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $211.64 / $705.53 / $705.53	Professional		$211.64	$705.53	$705.53
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $62.87 / $133.59 / $133.59	Professional	26	$62.87	$133.59	$133.59
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.95 / $96.95 / $259.77	Facility	26	$96.95	$96.95	$259.77
Cigna Facility/Professional Professional Modifier Low / Median / High Price $250.15 / $478.96 / $917.58	Professional		$250.15	$478.96	$917.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.42 / $105.35 / $179.70	Professional	26	$60.42	$105.35	$179.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $187.98 / $364.47 / $740.61	Professional	TC	$187.98	$364.47	$740.61
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $94.45 / $94.45 / $94.45	Facility	26	$94.45	$94.45	$94.45
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $289.38 / $449.57 / $609.10	Professional		$289.38	$449.57	$609.10
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $66.11 / $98.27 / $126.61	Professional	26	$66.11	$98.27	$126.61
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $223.27 / $350.85 / $492.35	Professional	TC	$223.27	$350.85	$492.35
Molina Facility/Professional Professional Modifier Low / Median / High Price $97.00 / $268.78 / $469.93	Professional		$97.00	$268.78	$469.93
United Facility/Professional Professional Modifier Low / Median / High Price $296.73 / $407.67 / $779.45	Professional		$296.73	$407.67	$779.45
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.72 / $76.12 / $167.83	Professional	26	$66.72	$76.12	$167.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $226.26 / $323.81 / $606.05	Professional	TC	$226.26	$323.81	$606.05
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $238.16 / $238.16 / $238.16	Professional		$238.16	$238.16	$238.16
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $58.04 / $58.04 / $58.04	Professional	26	$58.04	$58.04	$58.04
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $180.12 / $180.12 / $180.12	Professional	TC	$180.12	$180.12	$180.12