Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $51.30 / $154.75	Facility	26	$51.29	$51.30	$154.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $123.05 / $171.59 / $357.42	Professional		$123.05	$171.59	$357.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.08 / $51.30 / $125.10	Professional	26	$44.08	$51.30	$125.10
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $360.45 / $360.45 / $964.54	Professional	50	$360.45	$360.45	$964.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $84.45 / $119.70 / $225.03	Professional	TC	$84.45	$119.70	$225.03
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $76.65 / $98.32 / $127.82	Professional		$76.65	$98.32	$127.82
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $34.57 / $45.24 / $97.36	Professional	26	$34.57	$45.24	$97.36
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $59.03 / $59.03 / $98.03	Professional	TC	$59.03	$59.03	$98.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.02 / $54.02 / $146.02	Facility	26	$54.02	$54.02	$146.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $96.02 / $201.85 / $396.46	Professional		$96.02	$201.85	$396.46
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.13 / $57.00 / $101.50	Professional	26	$33.13	$57.00	$101.50
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $231.80 / $231.80 / $231.80	Professional	50	$231.80	$231.80	$231.80
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $65.34 / $147.59 / $284.00	Professional	TC	$65.34	$147.59	$284.00
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $53.23 / $53.23 / $53.23	Facility	26	$53.23	$53.23	$53.23
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $122.90 / $202.80 / $280.86	Professional		$122.90	$202.80	$280.86
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $37.26 / $55.39 / $69.87	Professional	26	$37.26	$55.39	$69.87
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $85.19 / $147.41 / $201.01	Professional	TC	$85.19	$147.41	$201.01
Molina Facility/Professional Professional Modifier Low / Median / High Price $37.20 / $111.13 / $191.61	Professional		$37.20	$111.13	$191.61
United Facility/Professional Professional Modifier Low / Median / High Price $121.42 / $175.78 / $320.39	Professional		$121.42	$175.78	$320.39
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.99 / $44.81 / $94.51	Professional	26	$37.99	$44.81	$94.51
United Facility/Professional Professional Modifier TC Low / Median / High Price $80.43 / $127.15 / $242.46	Professional	TC	$80.43	$127.15	$242.46
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $99.87 / $99.87 / $99.87	Professional		$99.87	$99.87	$99.87
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $35.13 / $35.13 / $35.13	Professional	26	$35.13	$35.13	$35.13
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $64.73 / $64.73 / $64.73	Professional	TC	$64.73	$64.73	$64.73