Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $83.18 / $251.19 / $645.65	Facility		$83.18	$251.19	$645.65
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.88 / $23.99 / $109.65	Facility	26	$21.88	$23.99	$109.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $97.72 / $323.59	Professional		$56.23	$97.72	$323.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $56.23 / $162.18	Professional	26	$25.70	$56.23	$162.18
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $51.29 / $186.21 / $630.96	Professional	50	$51.29	$186.21	$630.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $53.70 / $131.83	Professional	TC	$33.88	$53.70	$131.83
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $70.79 / $128.82	Professional		$58.88	$70.79	$128.82
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $30.90 / $54.95	Professional	26	$24.55	$30.90	$54.95
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $83.18 / $114.82 / $169.82	Professional	50	$83.18	$114.82	$169.82
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $43.65 / $81.28	Professional	TC	$36.31	$43.65	$81.28
Cigna Facility/Professional Facility Modifier Low / Median / High Price $93.33 / $131.83 / $257.04	Facility		$93.33	$131.83	$257.04
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.94 / $37.15 / $63.10	Facility	26	$7.94	$37.15	$63.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $91.20 / $177.83	Professional		$58.88	$91.20	$177.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $37.15 / $72.44	Professional	26	$22.91	$37.15	$72.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $57.54 / $114.82	Professional	TC	$35.48	$57.54	$114.82
Florida Blue Facility/Professional Facility Modifier Low / Median / High Price $75.86 / $134.90 / $229.09	Facility		$75.86	$134.90	$229.09
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $36.31 / $36.31 / $36.31	Facility	26	$36.31	$36.31	$36.31
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $81.28 / $123.03	Professional		$57.54	$81.28	$123.03
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $31.62 / $47.86	Professional	26	$22.39	$31.62	$47.86
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $50.12 / $75.86	Professional	TC	$34.67	$50.12	$75.86
Molina Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $33.88 / $81.28	Professional		$24.55	$33.88	$81.28
United Facility/Professional Facility Modifier Low / Median / High Price $39.81 / $74.13 / $151.36	Facility		$39.81	$74.13	$151.36
United Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $79.43 / $138.04	Professional		$66.07	$79.43	$138.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $30.90 / $54.95	Professional	26	$25.70	$30.90	$54.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $46.77 / $83.18	Professional	TC	$39.81	$46.77	$83.18
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $57.54 / $81.28	Professional		$57.54	$57.54	$81.28
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $21.88 / $31.62	Professional	26	$21.88	$21.88	$31.62
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $35.48 / $50.12	Professional	TC	$35.48	$35.48	$50.12