Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.69 / $83.18 / $630.96	Facility	26	$41.69	$83.18	$630.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $316.23 / $676.08	Professional		$213.80	$316.23	$676.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $64.57 / $162.18	Professional	26	$41.69	$64.57	$162.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $251.19 / $549.54	Professional	TC	$173.78	$251.19	$549.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $257.04 / $524.81	Professional		$239.88	$257.04	$524.81
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $81.28 / $100.00	Professional	26	$47.86	$81.28	$100.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.49 / $72.44 / $102.33	Facility	26	$15.49	$72.44	$102.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $371.54 / $630.96	Professional		$213.80	$371.54	$630.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $77.62 / $123.03	Professional	26	$44.67	$77.62	$123.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $295.12 / $512.86	Professional	TC	$169.82	$295.12	$512.86
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $229.09 / $457.09	Professional		$208.93	$229.09	$457.09
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $47.86 / $89.13	Professional	26	$44.67	$47.86	$89.13
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $181.97 / $371.54	Professional	TC	$165.96	$181.97	$371.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $128.82 / $234.42	Professional		$32.36	$128.82	$234.42
United Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $338.84 / $602.56	Professional		$257.04	$338.84	$602.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $69.18 / $128.82	Professional	26	$51.29	$69.18	$128.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $263.03 / $467.74	Professional	TC	$208.93	$263.03	$467.74
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $204.17 / $302.00	Professional		$141.25	$204.17	$302.00
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $41.69 / $63.10	Professional	26	$29.51	$41.69	$63.10
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $162.18 / $239.88	Professional	TC	$112.20	$162.18	$239.88