Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $26.98 / $277.92 / $490.91	Facility		$26.98	$277.92	$490.91
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.71 / $15.11 / $17.14	Facility	26	$14.71	$15.11	$17.14
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $223.94 / $298.77 / $470.91	Facility	TC	$223.94	$298.77	$470.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.28 / $54.00 / $106.90	Professional		$28.28	$54.00	$106.90
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $71.59 / $71.59 / $71.59	Professional	25	$71.59	$71.59	$71.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.71 / $21.89 / $36.42	Professional	26	$14.71	$21.89	$36.42
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $141.08 / $143.78 / $234.74	Professional	50	$141.08	$143.78	$234.74
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $13.49 / $18.82 / $37.50	Professional	52	$13.49	$18.82	$37.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $12.28 / $23.08 / $64.06	Professional	TC	$12.28	$23.08	$64.06
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $27.32 / $45.95 / $45.95	Professional		$27.32	$45.95	$45.95
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $32.22 / $32.22 / $32.22	Professional	26	$32.22	$32.22	$32.22
Cigna Facility/Professional Facility Modifier Low / Median / High Price $41.38 / $50.78 / $63.36	Facility		$41.38	$50.78	$63.36
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.35 / $23.35 / $62.57	Facility	26	$23.35	$23.35	$62.57
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $18.64 / $18.64 / $99.12	Facility	TC	$18.64	$18.64	$99.12
Cigna Facility/Professional Professional Modifier Low / Median / High Price $29.99 / $71.54 / $120.49	Professional		$29.99	$71.54	$120.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.41 / $27.86 / $43.26	Professional	26	$17.41	$27.86	$43.26
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $14.20 / $43.17 / $79.98	Professional	TC	$14.20	$43.17	$79.98
Florida Blue Facility/Professional Facility Modifier Low / Median / High Price $12.77 / $24.95 / $38.18	Facility		$12.77	$24.95	$38.18
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $24.19 / $45.60 / $77.52	Professional		$24.19	$45.60	$77.52
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $12.86 / $20.19 / $28.16	Professional	26	$12.86	$20.19	$28.16
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $10.55 / $22.66 / $49.25	Professional	TC	$10.55	$22.66	$49.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $18.78 / $34.27 / $56.73	Professional		$18.78	$34.27	$56.73
United Facility/Professional Professional Modifier Low / Median / High Price $39.63 / $58.28 / $118.65	Professional		$39.63	$58.28	$118.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.10 / $24.35 / $42.86	Professional	26	$17.10	$24.35	$42.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.25 / $37.65 / $82.69	Professional	TC	$20.25	$37.65	$82.69
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $28.09 / $28.09 / $28.09	Professional		$28.09	$28.09	$28.09
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $15.58 / $15.58 / $15.58	Professional	26	$15.58	$15.58	$15.58
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $12.51 / $12.51 / $16.07	Professional	TC	$12.51	$12.51	$16.07