Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $99.20 / $423.50 / $1,167.66	Facility		$99.20	$423.50	$1,167.66
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.62 / $29.69 / $113.07	Facility	26	$23.62	$29.69	$113.07
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $48.24 / $284.07 / $534.05	Facility	TC	$48.24	$284.07	$534.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $71.87 / $110.48 / $343.97	Professional		$71.87	$110.48	$343.97
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.62 / $34.72 / $120.97	Professional	26	$23.62	$34.72	$120.97
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $35.94 / $46.30 / $63.22	Professional	52	$35.94	$46.30	$63.22
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $48.24 / $71.39 / $144.37	Professional	TC	$48.24	$71.39	$144.37
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $67.15 / $84.68 / $162.97	Professional		$67.15	$84.68	$162.97
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.78 / $34.52 / $71.14	Professional	26	$25.78	$34.52	$71.14
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $52.34 / $56.96 / $84.13	Professional	TC	$52.34	$56.96	$84.13
Cigna Facility/Professional Facility Modifier Low / Median / High Price $91.69 / $210.42 / $327.61	Facility		$91.69	$210.42	$327.61
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.13 / $40.13 / $107.07	Facility	26	$40.13	$40.13	$107.07
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $82.40 / $82.40 / $215.57	Facility	TC	$82.40	$82.40	$215.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.56 / $119.55 / $233.21	Professional		$74.56	$119.55	$233.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.73 / $37.70 / $73.95	Professional	26	$24.73	$37.70	$73.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $49.85 / $81.18 / $158.74	Professional	TC	$49.85	$81.18	$158.74
Florida Blue Facility/Professional Facility Modifier Low / Median / High Price $112.81 / $265.27 / $425.20	Facility		$112.81	$265.27	$425.20
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $38.97 / $38.97 / $38.97	Facility	26	$38.97	$38.97	$38.97
Florida Blue Facility/Professional Facility Modifier TC Low / Median / High Price $79.78 / $79.78 / $79.78	Facility	TC	$79.78	$79.78	$79.78
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $70.47 / $115.80 / $157.78	Professional		$70.47	$115.80	$157.78
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $23.62 / $38.97 / $51.15	Professional	26	$23.62	$38.97	$51.15
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $46.85 / $77.78 / $107.03	Professional	TC	$46.85	$77.78	$107.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $37.14 / $83.14 / $143.97	Professional		$37.14	$83.14	$143.97
United Facility/Professional Facility Modifier Low / Median / High Price $99.32 / $196.15 / $567.40	Facility		$99.32	$196.15	$567.40
United Facility/Professional Professional Modifier Low / Median / High Price $87.63 / $105.31 / $195.15	Professional		$87.63	$105.31	$195.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.71 / $30.80 / $60.20	Professional	26	$27.71	$30.80	$60.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $58.58 / $73.22 / $127.26	Professional	TC	$58.58	$73.22	$127.26
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $67.77 / $67.77 / $67.77	Professional		$67.77	$67.77	$67.77
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $21.69 / $21.69 / $21.69	Professional	26	$21.69	$21.69	$21.69
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $46.08 / $46.08 / $46.08	Professional	TC	$46.08	$46.08	$46.08