Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.50 / $71.88 / $242.77	Facility	26	$62.50	$71.88	$242.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $204.47 / $375.00 / $600.00	Professional		$204.47	$375.00	$600.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.50 / $104.96 / $178.65	Professional	26	$62.50	$104.96	$178.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $136.12 / $249.00 / $393.75	Professional	TC	$136.12	$249.00	$393.75
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $118.12 / $141.74 / $303.69	Professional		$118.12	$141.74	$303.69
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $47.78 / $58.40 / $142.80	Professional	26	$47.78	$58.40	$142.80
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $149.90 / $149.90 / $149.90	Professional	TC	$149.90	$149.90	$149.90
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 $147.22 / $345.47 / $709.34	Professional		$147.22	$345.47	$709.34
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 $100.16 / $251.95 / $586.10	Professional	TC	$100.16	$251.95	$586.10
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 $219.14 / $380.17 / $535.19	Professional		$219.14	$380.17	$535.19
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $49.11 / $75.34 / $103.53	Professional	26	$49.11	$75.34	$103.53
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $156.49 / $307.98 / $447.23	Professional	TC	$156.49	$307.98	$447.23
Molina Facility/Professional Professional Modifier Low / Median / High Price $62.75 / $133.84 / $232.42	Professional		$62.75	$133.84	$232.42
United Facility/Professional Professional Modifier Low / Median / High Price $176.61 / $284.67 / $612.04	Professional		$176.61	$284.67	$612.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.15 / $62.06 / $130.93	Professional	26	$54.15	$62.06	$130.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $116.48 / $205.40 / $503.58	Professional	TC	$116.48	$205.40	$503.58
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $151.88 / $151.88 / $151.88	Professional		$151.88	$151.88	$151.88
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $51.55 / $51.55 / $51.55	Professional	26	$51.55	$51.55	$51.55
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $100.33 / $100.33 / $100.33	Professional	TC	$100.33	$100.33	$100.33