Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $38.59 / $290.30 / $625.21	Facility		$38.59	$290.30	$625.21
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $5.67 / $11.75 / $378.93	Facility	26	$5.67	$11.75	$378.93
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $17.03 / $218.24 / $439.61	Facility	TC	$17.03	$218.24	$439.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $20.48 / $33.11 / $98.80	Professional		$20.48	$33.11	$98.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.67 / $8.24 / $27.58	Professional	26	$5.67	$8.24	$27.58
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $51.06 / $112.88 / $135.84	Professional	50	$51.06	$112.88	$135.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $14.81 / $23.51 / $42.86	Professional	TC	$14.81	$23.51	$42.86
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $19.85 / $24.37 / $44.80	Professional		$19.85	$24.37	$44.80
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.14 / $7.76 / $15.08	Professional	26	$6.14	$7.76	$15.08
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $31.99 / $34.19 / $36.56	Professional	50	$31.99	$34.19	$36.56
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $17.42 / $17.85 / $34.09	Professional	TC	$17.42	$17.85	$34.09
Cigna Facility/Professional Facility Modifier Low / Median / High Price $28.38 / $99.23 / $163.37	Facility		$28.38	$99.23	$163.37
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.61 / $9.61 / $25.48	Facility	26	$9.61	$9.61	$25.48
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $27.59 / $27.59 / $63.58	Facility	TC	$27.59	$27.59	$63.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $22.34 / $34.94 / $64.87	Professional		$22.34	$34.94	$64.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.94 / $9.67 / $17.26	Professional	26	$5.94	$9.67	$17.26
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $38.75 / $38.75 / $38.75	Professional	50	$38.75	$38.75	$38.75
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.39 / $25.17 / $47.69	Professional	TC	$16.39	$25.17	$47.69
Florida Blue Facility/Professional Facility Modifier Low / Median / High Price $31.01 / $77.26 / $123.84	Facility		$31.01	$77.26	$123.84
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $9.30 / $9.30 / $9.30	Facility	26	$9.30	$9.30	$9.30
Florida Blue Facility/Professional Facility Modifier TC Low / Median / High Price $23.35 / $23.35 / $23.35	Facility	TC	$23.35	$23.35	$23.35
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $22.85 / $33.86 / $42.84	Professional		$22.85	$33.86	$42.84
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $6.04 / $9.72 / $12.20	Professional	26	$6.04	$9.72	$12.20
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $16.35 / $23.63 / $30.91	Professional	TC	$16.35	$23.63	$30.91
Molina Facility/Professional Professional Modifier Low / Median / High Price $15.17 / $33.42 / $55.11	Professional		$15.17	$33.42	$55.11
United Facility/Professional Professional Modifier Low / Median / High Price $23.74 / $27.87 / $56.51	Professional		$23.74	$27.87	$56.51
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.66 / $7.60 / $15.98	Professional	26	$6.66	$7.60	$15.98
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.05 / $20.35 / $40.20	Professional	TC	$17.05	$20.35	$40.20
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $18.51 / $18.51 / $18.51	Professional		$18.51	$18.51	$18.51
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $4.68 / $4.68 / $4.68	Professional	26	$4.68	$4.68	$4.68
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $13.84 / $13.84 / $13.84	Professional	TC	$13.84	$13.84	$13.84