Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.50 / $71.05 / $221.16	Facility	26	$62.50	$71.05	$221.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $240.91 / $374.53 / $525.00	Professional		$240.91	$374.53	$525.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.50 / $93.75 / $154.00	Professional	26	$62.50	$93.75	$154.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $173.77 / $259.35 / $369.35	Professional	TC	$173.77	$259.35	$369.35
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $136.24 / $156.69 / $212.87	Professional		$136.24	$156.69	$212.87
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.06 / $91.67 / $130.09	Professional	26	$35.06	$91.67	$130.09
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $72.95 / $72.95 / $196.08	Facility	26	$72.95	$72.95	$196.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $160.88 / $372.24 / $770.16	Professional		$160.88	$372.24	$770.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.14 / $72.17 / $142.40	Professional	26	$45.14	$72.17	$142.40
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $123.14 / $305.24 / $634.00	Professional	TC	$123.14	$305.24	$634.00
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $71.45 / $71.45 / $71.45	Facility	26	$71.45	$71.45	$71.45
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $215.82 / $364.93 / $518.53	Professional		$215.82	$364.93	$518.53
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $45.13 / $69.70 / $95.78	Professional	26	$45.13	$69.70	$95.78
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $169.73 / $281.87 / $444.63	Professional	TC	$169.73	$281.87	$444.63
Molina Facility/Professional Professional Modifier Low / Median / High Price $41.48 / $181.99 / $297.09	Professional		$41.48	$181.99	$297.09
United Facility/Professional Professional Modifier Low / Median / High Price $203.62 / $317.88 / $658.00	Professional		$203.62	$317.88	$658.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.64 / $57.91 / $120.68	Professional	26	$49.64	$57.91	$120.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $148.84 / $238.26 / $522.92	Professional	TC	$148.84	$238.26	$522.92
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $173.40 / $173.40 / $173.40	Professional		$173.40	$173.40	$173.40
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $46.95 / $46.95 / $46.95	Professional	26	$46.95	$46.95	$46.95
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $126.45 / $126.45 / $126.45	Professional	TC	$126.45	$126.45	$126.45