Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.00 / $45.65 / $62.00	Facility	26	$45.00	$45.65	$62.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $319.50 / $420.62 / $625.24	Professional		$319.50	$420.62	$625.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.53 / $57.27 / $101.51	Professional	26	$46.53	$57.27	$101.51
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $268.39 / $364.85 / $518.66	Professional	TC	$268.39	$364.85	$518.66
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $385.97 / $436.82 / $745.99	Professional		$385.97	$436.82	$745.99
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $54.48 / $69.23 / $93.49	Professional	26	$54.48	$69.23	$93.49
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $63.88 / $63.88 / $63.88	Facility	26	$63.88	$63.88	$63.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $270.86 / $508.34 / $947.34	Professional		$270.86	$508.34	$947.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.68 / $74.64 / $133.32	Professional	26	$47.68	$74.64	$133.32
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $237.54 / $441.45 / $833.02	Professional	TC	$237.54	$441.45	$833.02
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $120.59 / $290.51 / $452.81	Professional		$120.59	$290.51	$452.81
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $24.73 / $42.60 / $63.02	Professional	26	$24.73	$42.60	$63.02
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $93.69 / $253.24 / $384.43	Professional	TC	$93.69	$253.24	$384.43
Molina Facility/Professional Professional Modifier Low / Median / High Price $65.27 / $397.21 / $638.64	Professional		$65.27	$397.21	$638.64
United Facility/Professional Professional Modifier Low / Median / High Price $224.33 / $411.02 / $789.88	Professional		$224.33	$411.02	$789.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.94 / $60.73 / $112.58	Professional	26	$42.94	$60.73	$112.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $169.37 / $359.72 / $687.16	Professional	TC	$169.37	$359.72	$687.16
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $345.45 / $345.45 / $373.52	Professional		$345.45	$345.45	$373.52
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $42.38 / $42.38 / $45.83	Professional	26	$42.38	$42.38	$45.83
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $303.07 / $303.07 / $384.43	Professional	TC	$303.07	$303.07	$384.43