Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.50 / $72.27 / $293.93	Facility	26	$62.50	$72.27	$293.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $250.00 / $425.00 / $603.00	Professional		$250.00	$425.00	$603.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.50 / $104.00 / $154.00	Professional	26	$62.50	$104.00	$154.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $187.50 / $299.00 / $462.42	Professional	TC	$187.50	$299.00	$462.42
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $223.34 / $223.34 / $223.34	Professional		$223.34	$223.34	$223.34
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $64.40 / $123.18 / $142.25	Professional	26	$64.40	$123.18	$142.25
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.55 / $96.55 / $258.19	Facility	26	$96.55	$96.55	$258.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $244.55 / $497.12 / $937.39	Professional		$244.55	$497.12	$937.39
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.19 / $97.48 / $179.40	Professional	26	$60.19	$97.48	$179.40
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $191.30 / $388.00 / $765.20	Professional	TC	$191.30	$388.00	$765.20
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $94.72 / $94.72 / $94.72	Facility	26	$94.72	$94.72	$94.72
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $291.88 / $458.66 / $604.60	Professional		$291.88	$458.66	$604.60
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $66.30 / $98.27 / $126.82	Professional	26	$66.30	$98.27	$126.82
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $225.57 / $354.47 / $492.35	Professional	TC	$225.57	$354.47	$492.35
Molina Facility/Professional Professional Modifier Low / Median / High Price $95.09 / $262.83 / $461.90	Professional		$95.09	$262.83	$461.90
United Facility/Professional Professional Modifier Low / Median / High Price $298.08 / $408.90 / $778.35	Professional		$298.08	$408.90	$778.35
United Facility/Professional Professional Modifier 26 Low / Median / High Price $65.95 / $75.38 / $160.16	Professional	26	$65.95	$75.38	$160.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $225.32 / $325.58 / $617.32	Professional	TC	$225.32	$325.58	$617.32
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $238.94 / $238.94 / $238.94	Professional		$238.94	$238.94	$238.94
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $57.27 / $57.27 / $57.27	Professional	26	$57.27	$57.27	$57.27
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $181.67 / $181.67 / $181.67	Professional	TC	$181.67	$181.67	$181.67