Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.50 / $109.23 / $353.49	Facility	26	$62.50	$109.23	$353.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $250.00 / $428.68 / $761.25	Professional		$250.00	$428.68	$761.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.50 / $117.50 / $215.59	Professional	26	$62.50	$117.50	$215.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $187.50 / $330.39 / $565.00	Professional	TC	$187.50	$330.39	$565.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $246.30 / $293.07 / $630.79	Professional		$246.30	$293.07	$630.79
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $75.22 / $103.13 / $208.55	Professional	26	$75.22	$103.13	$208.55
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $116.52 / $116.52 / $312.18	Facility	26	$116.52	$116.52	$312.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $306.48 / $587.35 / $1,300.00	Professional		$306.48	$587.35	$1,300.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.18 / $125.07 / $210.00	Professional	26	$72.18	$125.07	$210.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $234.19 / $459.25 / $1,113.99	Professional	TC	$234.19	$459.25	$1,113.99
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $114.04 / $114.04 / $114.04	Facility	26	$114.04	$114.04	$114.04
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $363.37 / $571.01 / $908.43	Professional		$363.37	$571.01	$908.43
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $71.12 / $111.19 / $152.69	Professional	26	$71.12	$111.19	$152.69
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $283.54 / $445.56 / $753.88	Professional	TC	$283.54	$445.56	$753.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $95.09 / $301.01 / $539.73	Professional		$95.09	$301.01	$539.73
United Facility/Professional Professional Modifier Low / Median / High Price $370.72 / $535.14 / $1,157.77	Professional		$370.72	$535.14	$1,157.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $79.64 / $93.02 / $202.96	Professional	26	$79.64	$93.02	$202.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $282.58 / $414.46 / $931.62	Professional	TC	$282.58	$414.46	$931.62
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $296.98 / $296.98 / $296.98	Professional		$296.98	$296.98	$296.98
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $70.90 / $70.90 / $70.90	Professional	26	$70.90	$70.90	$70.90
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $226.08 / $226.08 / $226.08	Professional	TC	$226.08	$226.08	$226.08