Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.50 / $97.54 / $296.02	Facility	26	$62.50	$97.54	$296.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $250.00 / $371.24 / $546.25	Professional		$250.00	$371.24	$546.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.50 / $101.86 / $145.65	Professional	26	$62.50	$101.86	$145.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $187.50 / $262.50 / $385.24	Professional	TC	$187.50	$262.50	$385.24
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $162.96 / $182.33 / $586.05	Professional		$162.96	$182.33	$586.05
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $33.76 / $111.23 / $174.14	Professional	26	$33.76	$111.23	$174.14
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $97.16 / $97.16 / $260.12	Facility	26	$97.16	$97.16	$260.12
Cigna Facility/Professional Professional Modifier Low / Median / High Price $195.97 / $428.27 / $913.27	Professional		$195.97	$428.27	$913.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.38 / $100.11 / $192.36	Professional	26	$60.38	$100.11	$192.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $144.22 / $317.31 / $749.69	Professional	TC	$144.22	$317.31	$749.69
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $94.73 / $94.73 / $94.73	Facility	26	$94.73	$94.73	$94.73
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $236.74 / $393.16 / $651.79	Professional		$236.74	$393.16	$651.79
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $66.31 / $100.65 / $127.88	Professional	26	$66.31	$100.65	$127.88
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $176.52 / $283.04 / $504.68	Professional	TC	$176.52	$283.04	$504.68
Molina Facility/Professional Professional Modifier Low / Median / High Price $95.09 / $203.78 / $358.05	Professional		$95.09	$203.78	$358.05
United Facility/Professional Professional Modifier Low / Median / High Price $243.96 / $374.81 / $767.60	Professional		$243.96	$374.81	$767.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $67.69 / $78.84 / $166.67	Professional	26	$67.69	$78.84	$166.67
United Facility/Professional Professional Modifier TC Low / Median / High Price $173.42 / $266.64 / $588.63	Professional	TC	$173.42	$266.64	$588.63
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $199.33 / $199.33 / $199.33	Professional		$199.33	$199.33	$199.33
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $59.10 / $59.10 / $59.10	Professional	26	$59.10	$59.10	$59.10
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $140.24 / $140.24 / $140.24	Professional	TC	$140.24	$140.24	$140.24