Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $138.04 / $501.19 / $891.25	Facility		$138.04	$501.19	$891.25
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.20 / $19.50 / $95.50	Facility	26	$18.20	$19.50	$95.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $107.15 / $245.47	Professional		$69.18	$107.15	$245.47
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $30.90 / $77.62	Professional	26	$19.05	$30.90	$77.62
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $75.86 / $147.91	Professional	TC	$48.98	$75.86	$147.91
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $93.33 / $177.83	Professional		$81.28	$93.33	$177.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $26.92 / $43.65	Professional	26	$19.95	$26.92	$43.65
Cigna Facility/Professional Facility Modifier Low / Median / High Price $70.79 / $100.00 / $165.96	Facility		$70.79	$100.00	$165.96
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.46 / $30.20 / $42.66	Facility	26	$6.46	$30.20	$42.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $87.10 / $208.93	Professional		$60.26	$87.10	$208.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $25.70 / $52.48	Professional	26	$19.05	$25.70	$52.48
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $64.57 / $162.18	Professional	TC	$38.90	$64.57	$162.18
Florida Blue Facility/Professional Facility Modifier Low / Median / High Price $91.20 / $173.78 / $281.84	Facility		$91.20	$173.78	$281.84
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $81.28 / $112.20	Professional		$58.88	$81.28	$112.20
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $20.42 / $26.30	Professional	26	$19.05	$20.42	$26.30
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $63.10 / $81.28	Professional	TC	$35.48	$63.10	$81.28
Molina Facility/Professional Professional Modifier Low / Median / High Price $15.85 / $33.11 / $97.72	Professional		$15.85	$33.11	$97.72
United Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $85.11 / $138.04	Professional		$57.54	$85.11	$138.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $23.44 / $37.15	Professional	26	$19.95	$23.44	$37.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $61.66 / $100.00	Professional	TC	$37.15	$61.66	$100.00
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $58.88 / $117.49	Professional		$58.88	$58.88	$117.49
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $13.49 / $26.92	Professional	26	$13.49	$13.49	$26.92
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $44.67 / $91.20	Professional	TC	$44.67	$44.67	$91.20