Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $54.95 / $275.42 / $707.95	Facility		$54.95	$275.42	$707.95
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $5.50 / $9.12 / $380.19	Facility	26	$5.50	$9.12	$380.19
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $18.62 / $186.21 / $512.86	Facility	TC	$18.62	$186.21	$512.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $10.72 / $41.69 / $123.03	Professional		$10.72	$41.69	$123.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.61 / $12.88 / $46.77	Professional	26	$6.61	$12.88	$46.77
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $18.20 / $74.13 / $194.98	Professional	50	$18.20	$74.13	$194.98
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $32.36 / $44.67 / $95.50	Professional	52	$32.36	$44.67	$95.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $32.36 / $77.62	Professional	TC	$17.38	$32.36	$77.62
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $21.38 / $27.54 / $50.12	Professional		$21.38	$27.54	$50.12
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.03 / $8.32 / $13.49	Professional	26	$6.03	$8.32	$13.49
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $30.90 / $39.81 / $64.57	Professional	50	$30.90	$39.81	$64.57
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $16.60 / $22.91 / $38.90	Professional	TC	$16.60	$22.91	$38.90
Cigna Facility/Professional Facility Modifier Low / Median / High Price $52.48 / $104.71 / $177.83	Facility		$52.48	$104.71	$177.83
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $1.95 / $9.12 / $15.85	Facility	26	$1.95	$9.12	$15.85
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $6.03 / $28.18 / $40.74	Facility	TC	$6.03	$28.18	$40.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $21.88 / $30.90 / $64.57	Professional		$21.88	$30.90	$64.57
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.75 / $9.12 / $18.62	Professional	26	$5.75	$9.12	$18.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.22 / $23.44 / $52.48	Professional	TC	$16.22	$23.44	$52.48
Florida Blue Facility/Professional Facility Modifier Low / Median / High Price $19.95 / $61.66 / $114.82	Facility		$19.95	$61.66	$114.82
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $8.91 / $8.91 / $8.91	Facility	26	$8.91	$8.91	$8.91
Florida Blue Facility/Professional Facility Modifier TC Low / Median / High Price $21.38 / $21.38 / $21.38	Facility	TC	$21.38	$21.38	$21.38
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $22.91 / $27.54 / $43.65	Professional		$22.91	$27.54	$43.65
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $5.62 / $7.94 / $11.75	Professional	26	$5.62	$7.94	$11.75
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $16.22 / $19.50 / $32.36	Professional	TC	$16.22	$19.50	$32.36
Molina Facility/Professional Professional Modifier Low / Median / High Price $5.13 / $21.88 / $35.48	Professional		$5.13	$21.88	$35.48
United Facility/Professional Facility Modifier Low / Median / High Price $12.02 / $64.57 / $144.54	Facility		$12.02	$64.57	$144.54
United Facility/Professional Professional Modifier Low / Median / High Price $22.91 / $28.18 / $51.29	Professional		$22.91	$28.18	$51.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $7.59 / $14.13	Professional	26	$6.46	$7.59	$14.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.22 / $20.42 / $37.15	Professional	TC	$16.22	$20.42	$37.15
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $19.05 / $19.05 / $33.11	Professional		$19.05	$19.05	$33.11
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $4.47 / $4.47 / $7.94	Professional	26	$4.47	$4.47	$7.94
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $14.45 / $14.45 / $25.12	Professional	TC	$14.45	$14.45	$25.12