Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $83.65 / $242.16 / $669.06	Facility		$83.65	$242.16	$669.06
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.05 / $25.36 / $104.46	Facility	26	$22.05	$25.36	$104.46
Aetna Facility/Professional Professional Modifier Low / Median / High Price $56.24 / $83.70 / $239.36	Professional		$56.24	$83.70	$239.36
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.05 / $31.62 / $111.81	Professional	26	$22.05	$31.62	$111.81
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $108.33 / $433.38 / $601.50	Professional	50	$108.33	$433.38	$601.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $34.19 / $48.26 / $96.70	Professional	TC	$34.19	$48.26	$96.70
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $55.58 / $69.87 / $138.54	Professional		$55.58	$69.87	$138.54
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $24.06 / $33.47 / $63.57	Professional	26	$24.06	$33.47	$63.57
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $85.75 / $104.79 / $267.98	Professional	50	$85.75	$104.79	$267.98
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $35.94 / $39.09 / $44.55	Professional	TC	$35.94	$39.09	$44.55
Cigna Facility/Professional Facility Modifier Low / Median / High Price $84.53 / $128.63 / $236.31	Facility		$84.53	$128.63	$236.31
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.03 / $37.03 / $99.03	Facility	26	$37.03	$37.03	$99.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $58.66 / $91.76 / $177.10	Professional		$58.66	$91.76	$177.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.08 / $36.45 / $71.00	Professional	26	$23.08	$36.45	$71.00
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $113.75 / $113.75 / $193.83	Professional	50	$113.75	$113.75	$193.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $35.57 / $56.10 / $111.24	Professional	TC	$35.57	$56.10	$111.24
Florida Blue Facility/Professional Facility Modifier Low / Median / High Price $76.55 / $144.41 / $228.10	Facility		$76.55	$144.41	$228.10
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $36.09 / $36.09 / $36.09	Facility	26	$36.09	$36.09	$36.09
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $55.58 / $88.67 / $121.78	Professional		$55.58	$88.67	$121.78
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $22.05 / $35.42 / $47.37	Professional	26	$22.05	$35.42	$47.37
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $33.54 / $53.25 / $74.40	Professional	TC	$33.54	$53.25	$74.40
Molina Facility/Professional Professional Modifier Low / Median / High Price $36.56 / $82.31 / $141.05	Professional		$36.56	$82.31	$141.05
United Facility/Professional Facility Modifier Low / Median / High Price $71.83 / $145.62 / $404.03	Facility		$71.83	$145.62	$404.03
United Facility/Professional Professional Modifier Low / Median / High Price $67.31 / $74.26 / $138.60	Professional		$67.31	$74.26	$138.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.46 / $29.75 / $55.87	Professional	26	$26.46	$29.75	$55.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $40.25 / $45.33 / $84.69	Professional	TC	$40.25	$45.33	$84.69
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $51.95 / $51.95 / $51.95	Professional		$51.95	$51.95	$51.95
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $19.55 / $19.55 / $19.55	Professional	26	$19.55	$19.55	$19.55
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $32.39 / $32.39 / $32.39	Professional	TC	$32.39	$32.39	$32.39