Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.50 / $103.64 / $419.19	Facility	26	$62.50	$103.64	$419.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $250.00 / $425.00 / $766.88	Professional		$250.00	$425.00	$766.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.50 / $127.03 / $285.35	Professional	26	$62.50	$127.03	$285.35
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $187.50 / $299.00 / $467.55	Professional	TC	$187.50	$299.00	$467.55
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $218.34 / $286.44 / $559.17	Professional		$218.34	$286.44	$559.17
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $90.30 / $158.99 / $246.58	Professional	26	$90.30	$158.99	$246.58
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $139.38 / $139.38 / $369.49	Facility	26	$139.38	$139.38	$369.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $276.51 / $525.00 / $1,025.08	Professional		$276.51	$525.00	$1,025.08
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.97 / $135.00 / $257.13	Professional	26	$85.97	$135.00	$257.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $184.04 / $368.68 / $778.89	Professional	TC	$184.04	$368.68	$778.89
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $134.94 / $134.94 / $134.94	Facility	26	$134.94	$134.94	$134.94
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $309.01 / $501.88 / $748.00	Professional		$309.01	$501.88	$748.00
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $94.47 / $140.01 / $181.50	Professional	26	$94.47	$140.01	$181.50
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $214.54 / $356.29 / $581.50	Professional	TC	$214.54	$356.29	$581.50
Molina Facility/Professional Professional Modifier Low / Median / High Price $127.44 / $254.04 / $464.54	Professional		$127.44	$254.04	$464.54
United Facility/Professional Professional Modifier Low / Median / High Price $322.77 / $447.91 / $896.53	Professional		$322.77	$447.91	$896.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $95.66 / $110.52 / $243.02	Professional	26	$95.66	$110.52	$243.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $222.23 / $310.62 / $666.13	Professional	TC	$222.23	$310.62	$666.13
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $259.06 / $259.06 / $259.06	Professional		$259.06	$259.06	$259.06
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $83.43 / $83.43 / $83.43	Professional	26	$83.43	$83.43	$83.43
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $175.63 / $175.63 / $175.63	Professional	TC	$175.63	$175.63	$175.63