Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $131.63 / $412.56 / $882.00	Facility		$131.63	$412.56	$882.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.79 / $18.37 / $19.63	Facility	26	$17.79	$18.37	$19.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.75 / $144.57 / $288.80	Professional		$109.75	$144.57	$288.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.57 / $21.91 / $37.49	Professional	26	$18.57	$21.91	$37.49
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $54.88 / $62.68 / $89.13	Professional	52	$54.88	$62.68	$89.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $91.19 / $118.68 / $197.70	Professional	TC	$91.19	$118.68	$197.70
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $84.36 / $106.12 / $186.93	Professional		$84.36	$106.12	$186.93
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $15.36 / $28.19 / $38.19	Professional	26	$15.36	$28.19	$38.19
Cigna Facility/Professional Facility Modifier Low / Median / High Price $102.66 / $298.94 / $754.00	Facility		$102.66	$298.94	$754.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.72 / $24.72 / $65.34	Facility	26	$24.72	$24.72	$65.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $109.68 / $179.10 / $313.49	Professional		$109.68	$179.10	$313.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.04 / $30.10 / $52.15	Professional	26	$20.04	$30.10	$52.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $97.66 / $158.53 / $269.41	Professional	TC	$97.66	$158.53	$269.41
Florida Blue Facility/Professional Facility Modifier Low / Median / High Price $147.15 / $318.12 / $509.89	Facility		$147.15	$318.12	$509.89
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $24.43 / $24.43 / $24.43	Facility	26	$24.43	$24.43	$24.43
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $84.36 / $137.72 / $202.14	Professional		$84.36	$137.72	$202.14
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $14.62 / $25.35 / $32.14	Professional	26	$14.62	$25.35	$32.14
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $69.73 / $109.73 / $167.21	Professional	TC	$69.73	$109.73	$167.21
Molina Facility/Professional Professional Modifier Low / Median / High Price $74.90 / $109.62 / $179.91	Professional		$74.90	$109.62	$179.91
United Facility/Professional Professional Modifier Low / Median / High Price $103.76 / $161.97 / $277.88	Professional		$103.76	$161.97	$277.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $18.00 / $25.72 / $48.03	Professional	26	$18.00	$25.72	$48.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $90.19 / $143.63 / $239.23	Professional	TC	$90.19	$143.63	$239.23
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $99.32 / $99.32 / $99.32	Professional		$99.32	$99.32	$99.32
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $16.09 / $16.09 / $16.09	Professional	26	$16.09	$16.09	$16.09
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $83.23 / $83.23 / $105.99	Professional	TC	$83.23	$83.23	$105.99