Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $128.82 / $489.78	Facility	26	$100.00	$128.82	$489.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $281.84 / $645.65	Professional		$186.21	$281.84	$645.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $162.18 / $426.58	Professional	26	$100.00	$162.18	$426.58
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $131.83 / $251.19	Professional	TC	$85.11	$131.83	$251.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $275.42 / $275.42	Professional		$275.42	$275.42	$275.42
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $162.18 / $263.03	Professional	26	$117.49	$162.18	$263.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.15 / $173.78 / $251.19	Facility	26	$37.15	$173.78	$251.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $346.74 / $512.86	Professional		$223.87	$346.74	$512.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $190.55 / $275.42	Professional	26	$120.23	$190.55	$275.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $162.18 / $251.19	Professional	TC	$109.65	$162.18	$251.19
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $213.80 / $331.13	Professional		$199.53	$213.80	$331.13
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $112.20 / $173.78	Professional	26	$107.15	$112.20	$173.78
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $100.00 / $154.88	Professional	TC	$93.33	$100.00	$154.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $104.71 / $239.88	Professional		$32.36	$104.71	$239.88
United Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $295.12 / $501.19	Professional		$223.87	$295.12	$501.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $158.49 / $263.03	Professional	26	$120.23	$158.49	$263.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $138.04 / $234.42	Professional	TC	$104.71	$138.04	$234.42
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $181.97 / $281.84	Professional		$181.97	$181.97	$281.84
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $95.50 / $151.36	Professional	26	$95.50	$95.50	$151.36
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $85.11 / $131.83	Professional	TC	$85.11	$85.11	$131.83