Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $101.21 / $179.86 / $324.00	Facility		$101.21	$179.86	$324.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.06 / $20.04 / $27.37	Facility	26	$11.06	$20.04	$27.37
Aetna Facility/Professional Professional Modifier Low / Median / High Price $104.18 / $126.22 / $194.88	Professional		$104.18	$126.22	$194.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.77 / $22.64 / $34.11	Professional	26	$11.77	$22.64	$34.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $84.14 / $105.09 / $160.76	Professional	TC	$84.14	$105.09	$160.76
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $107.71 / $107.71 / $169.90	Professional		$107.71	$107.71	$169.90
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $18.27 / $30.83 / $50.69	Professional	26	$18.27	$30.83	$50.69
Cigna Facility/Professional Facility Modifier Low / Median / High Price $147.68 / $147.68 / $454.44	Facility		$147.68	$147.68	$454.44
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.75 / $26.75 / $73.63	Facility	26	$26.75	$26.75	$73.63
Cigna Facility/Professional Professional Modifier Low / Median / High Price $133.02 / $200.55 / $346.64	Professional		$133.02	$200.55	$346.64
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.69 / $26.37 / $49.64	Professional	26	$14.69	$26.37	$49.64
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $112.30 / $173.18 / $310.31	Professional	TC	$112.30	$173.18	$310.31
Florida Blue Facility/Professional Facility Modifier Low / Median / High Price $505.46 / $505.46 / $505.46	Facility		$505.46	$505.46	$505.46
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $79.79 / $150.05 / $197.01	Professional		$79.79	$150.05	$197.01
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $5.73 / $15.78 / $27.53	Professional	26	$5.73	$15.78	$27.53
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $74.05 / $124.60 / $172.32	Professional	TC	$74.05	$124.60	$172.32
Molina Facility/Professional Professional Modifier Low / Median / High Price $33.19 / $114.35 / $184.76	Professional		$33.19	$114.35	$184.76
United Facility/Professional Professional Modifier Low / Median / High Price $121.07 / $168.88 / $274.75	Professional		$121.07	$168.88	$274.75
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.26 / $21.88 / $40.51	Professional	26	$11.26	$21.88	$40.51
United Facility/Professional Professional Modifier TC Low / Median / High Price $100.77 / $149.46 / $241.88	Professional	TC	$100.77	$149.46	$241.88
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $110.81 / $110.81 / $130.69	Professional		$110.81	$110.81	$130.69
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $17.36 / $17.36 / $23.73	Professional	26	$17.36	$17.36	$23.73
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $93.45 / $93.45 / $106.96	Professional	TC	$93.45	$93.45	$106.96