Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $152.46 / $530.76 / $993.05	Facility		$152.46	$530.76	$993.05
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.38 / $31.90 / $41.54	Facility	26	$28.38	$31.90	$41.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $152.13 / $192.84 / $382.23	Professional		$152.13	$192.84	$382.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.60 / $37.10 / $73.54	Professional	26	$30.60	$37.10	$73.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $119.31 / $150.87 / $260.56	Professional	TC	$119.31	$150.87	$260.56
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $125.77 / $141.44 / $196.12	Professional		$125.77	$141.44	$196.12
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.62 / $51.65 / $69.34	Professional	26	$28.62	$51.65	$69.34
Cigna Facility/Professional Facility Modifier Low / Median / High Price $172.29 / $440.54 / $754.00	Facility		$172.29	$440.54	$754.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.31 / $43.31 / $117.20	Facility	26	$43.31	$43.31	$117.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $163.41 / $261.86 / $457.17	Professional		$163.41	$261.86	$457.17
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.78 / $49.52 / $89.61	Professional	26	$32.78	$49.52	$89.61
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $130.47 / $212.89 / $374.68	Professional	TC	$130.47	$212.89	$374.68
Florida Blue Facility/Professional Facility Modifier Low / Median / High Price $190.16 / $553.78 / $887.60	Facility		$190.16	$553.78	$887.60
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $43.18 / $43.18 / $43.18	Facility	26	$43.18	$43.18	$43.18
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $117.38 / $195.16 / $272.80	Professional		$117.38	$195.16	$272.80
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $26.78 / $39.09 / $56.14	Professional	26	$26.78	$39.09	$56.14
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $90.60 / $160.41 / $218.81	Professional	TC	$90.60	$160.41	$218.81
Molina Facility/Professional Professional Modifier Low / Median / High Price $38.75 / $157.04 / $254.04	Professional		$38.75	$157.04	$254.04
United Facility/Professional Professional Modifier Low / Median / High Price $152.13 / $226.61 / $387.95	Professional		$152.13	$226.61	$387.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.88 / $41.26 / $77.73	Professional	26	$28.88	$41.26	$77.73
United Facility/Professional Professional Modifier TC Low / Median / High Price $121.26 / $186.41 / $324.70	Professional	TC	$121.26	$186.41	$324.70
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $137.36 / $137.36 / $137.36	Professional		$137.36	$137.36	$137.36
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $29.11 / $29.11 / $29.11	Professional	26	$29.11	$29.11	$29.11
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $108.25 / $108.25 / $137.62	Professional	TC	$108.25	$108.25	$137.62