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 / $286.89	Facility	26	$62.50	$71.88	$286.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $250.00 / $389.06 / $569.36	Professional		$250.00	$389.06	$569.36
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.50 / $102.59 / $145.65	Professional	26	$62.50	$102.59	$145.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $187.50 / $282.87 / $432.45	Professional	TC	$187.50	$282.87	$432.45
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $182.18 / $229.14 / $299.52	Professional		$182.18	$229.14	$299.52
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $62.89 / $131.18 / $168.76	Professional	26	$62.89	$131.18	$168.76
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.41 / $93.41 / $252.09	Facility	26	$93.41	$93.41	$252.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $227.88 / $456.67 / $909.78	Professional		$227.88	$456.67	$909.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.30 / $100.62 / $166.12	Professional	26	$58.30	$100.62	$166.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $173.39 / $352.48 / $748.59	Professional	TC	$173.39	$352.48	$748.59
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $92.21 / $92.21 / $92.21	Facility	26	$92.21	$92.21	$92.21
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $324.49 / $507.38 / $678.48	Professional		$324.49	$507.38	$678.48
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $58.12 / $89.90 / $123.45	Professional	26	$58.12	$89.90	$123.45
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $243.71 / $417.75 / $569.66	Professional	TC	$243.71	$417.75	$569.66
Molina Facility/Professional Professional Modifier Low / Median / High Price $95.09 / $233.80 / $411.77	Professional		$95.09	$233.80	$411.77
United Facility/Professional Professional Modifier Low / Median / High Price $274.52 / $412.17 / $821.56	Professional		$274.52	$412.17	$821.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.44 / $73.65 / $156.00	Professional	26	$64.44	$73.65	$156.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $203.46 / $324.85 / $689.48	Professional	TC	$203.46	$324.85	$689.48
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $228.47 / $228.47 / $228.47	Professional		$228.47	$228.47	$228.47
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $59.26 / $59.26 / $59.26	Professional	26	$59.26	$59.26	$59.26
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $169.21 / $169.21 / $169.21	Professional	TC	$169.21	$169.21	$169.21