Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $89.13 / $89.13 / $489.78	Facility		$89.13	$89.13	$489.78
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $95.50 / $95.50 / $95.50	Facility	26	$95.50	$95.50	$95.50
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $181.97 / $181.97 / $501.19	Facility	TC	$181.97	$181.97	$501.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $100.00 / $346.74	Professional		$64.57	$100.00	$346.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $64.57 / $309.03	Professional	26	$25.70	$64.57	$309.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $64.57 / $186.21	Professional	TC	$42.66	$64.57	$186.21
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $79.43 / $154.88	Professional		$52.48	$79.43	$154.88
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $23.99 / $52.48	Professional	26	$14.13	$23.99	$52.48
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $37.15 / $53.70	Professional	TC	$35.48	$37.15	$53.70
Cigna Facility/Professional Facility Modifier Low / Median / High Price $53.70 / $53.70 / $53.70	Facility		$53.70	$53.70	$53.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $83.18 / $158.49	Professional		$47.86	$83.18	$158.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $30.20 / $63.10	Professional	26	$17.38	$30.20	$63.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $50.12 / $109.65	Professional	TC	$28.18	$50.12	$109.65
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $89.13 / $177.83	Professional		$72.44	$89.13	$177.83
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $43.65 / $77.62	Professional	26	$30.20	$43.65	$77.62
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $50.12 / $102.33	Professional	TC	$28.84	$50.12	$102.33
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $109.65	Professional		$32.36	$33.11	$109.65
United Facility/Professional Facility Modifier Low / Median / High Price $13.80 / $34.67 / $87.10	Facility		$13.80	$34.67	$87.10
United Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $64.57 / $239.88	Professional		$48.98	$64.57	$239.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $25.12 / $91.20	Professional	26	$16.60	$25.12	$91.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $42.66 / $141.25	Professional	TC	$32.36	$42.66	$141.25
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $85.11 / $85.11	Professional		$38.90	$85.11	$85.11
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $25.70 / $25.70	Professional	26	$11.48	$25.70	$25.70
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $60.26 / $60.26	Professional	TC	$26.92	$60.26	$60.26