Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.50 / $72.00 / $295.06	Facility	26	$62.50	$72.00	$295.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $250.00 / $425.00 / $630.00	Professional		$250.00	$425.00	$630.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.50 / $106.31 / $155.65	Professional	26	$62.50	$106.31	$155.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $187.50 / $299.00 / $470.49	Professional	TC	$187.50	$299.00	$470.49
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $111.14 / $330.24 / $714.47	Professional		$111.14	$330.24	$714.47
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $47.02 / $65.45 / $122.73	Professional	26	$47.02	$65.45	$122.73
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.55 / $96.55 / $259.17	Facility	26	$96.55	$96.55	$259.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $252.76 / $482.77 / $911.85	Professional		$252.76	$482.77	$911.85
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.19 / $104.90 / $178.28	Professional	26	$60.19	$104.90	$178.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $190.83 / $367.66 / $740.91	Professional	TC	$190.83	$367.66	$740.91
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 $293.16 / $455.45 / $608.72	Professional		$293.16	$455.45	$608.72
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 $226.86 / $356.49 / $492.35	Professional	TC	$226.86	$356.49	$492.35
Molina Facility/Professional Professional Modifier Low / Median / High Price $97.00 / $268.78 / $472.54	Professional		$97.00	$268.78	$472.54
United Facility/Professional Professional Modifier Low / Median / High Price $299.08 / $404.63 / $786.61	Professional		$299.08	$404.63	$786.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $65.95 / $75.67 / $155.76	Professional	26	$65.95	$75.67	$155.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $229.26 / $327.56 / $638.91	Professional	TC	$229.26	$327.56	$638.91
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $239.51 / $239.51 / $239.51	Professional		$239.51	$239.51	$239.51
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $57.63 / $57.63 / $57.63	Professional	26	$57.63	$57.63	$57.63
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $181.88 / $181.88 / $181.88	Professional	TC	$181.88	$181.88	$181.88