Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $45.61 / $269.36 / $784.98	Facility		$45.61	$269.36	$784.98
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $5.23 / $7.35 / $26.91	Facility	26	$5.23	$7.35	$26.91
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $15.85 / $189.98 / $422.68	Facility	TC	$15.85	$189.98	$422.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $20.04 / $29.43 / $95.00	Professional		$20.04	$29.43	$95.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.23 / $7.84 / $38.84	Professional	26	$5.23	$7.84	$38.84
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $14.85 / $59.40 / $119.28	Professional	50	$14.85	$59.40	$119.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $14.81 / $20.49 / $42.37	Professional	TC	$14.81	$20.49	$42.37
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $19.82 / $24.94 / $46.59	Professional		$19.82	$24.94	$46.59
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.70 / $9.26 / $15.83	Professional	26	$5.70	$9.26	$15.83
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $31.08 / $35.44 / $45.86	Professional	50	$31.08	$35.44	$45.86
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $17.60 / $18.75 / $36.15	Professional	TC	$17.60	$18.75	$36.15
Cigna Facility/Professional Facility Modifier Low / Median / High Price $26.55 / $99.23 / $163.37	Facility		$26.55	$99.23	$163.37
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.86 / $8.86 / $24.47	Facility	26	$8.86	$8.86	$24.47
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $26.85 / $26.85 / $56.67	Facility	TC	$26.85	$26.85	$56.67
Cigna Facility/Professional Professional Modifier Low / Median / High Price $20.11 / $30.42 / $58.74	Professional		$20.11	$30.42	$58.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.48 / $9.49 / $16.68	Professional	26	$5.48	$9.49	$16.68
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $38.29 / $38.29 / $38.29	Professional	50	$38.29	$38.29	$38.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.17 / $22.43 / $44.06	Professional	TC	$15.17	$22.43	$44.06
Florida Blue Facility/Professional Facility Modifier Low / Median / High Price $28.58 / $70.17 / $112.47	Facility		$28.58	$70.17	$112.47
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $8.94 / $8.94 / $8.94	Facility	26	$8.94	$8.94	$8.94
Florida Blue Facility/Professional Facility Modifier TC Low / Median / High Price $21.15 / $21.15 / $21.15	Facility	TC	$21.15	$21.15	$21.15
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $21.81 / $31.05 / $40.47	Professional		$21.81	$31.05	$40.47
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $5.58 / $9.36 / $11.74	Professional	26	$5.58	$9.36	$11.74
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $15.44 / $21.20 / $30.49	Professional	TC	$15.44	$21.20	$30.49
Molina Facility/Professional Professional Modifier Low / Median / High Price $14.22 / $33.37 / $55.11	Professional		$14.22	$33.37	$55.11
United Facility/Professional Facility Modifier Low / Median / High Price $179.57 / $179.57 / $404.03	Facility		$179.57	$179.57	$404.03
United Facility/Professional Professional Modifier Low / Median / High Price $21.15 / $25.42 / $54.68	Professional		$21.15	$25.42	$54.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.33 / $7.24 / $14.72	Professional	26	$6.33	$7.24	$14.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $14.43 / $18.53 / $38.14	Professional	TC	$14.43	$18.53	$38.14
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $17.05 / $17.05 / $17.05	Professional		$17.05	$17.05	$17.05
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $4.13 / $4.13 / $4.13	Professional	26	$4.13	$4.13	$4.13
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $12.92 / $12.92 / $12.92	Professional	TC	$12.92	$12.92	$12.92