Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $54.55 / $314.94 / $648.00	Facility		$54.55	$314.94	$648.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.02 / $12.08 / $27.48	Facility	26	$8.02	$12.08	$27.48
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $24.54 / $183.14 / $474.95	Facility	TC	$24.54	$183.14	$474.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $16.57 / $40.88 / $120.53	Professional		$16.57	$40.88	$120.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.56 / $12.73 / $52.25	Professional	26	$8.56	$12.73	$52.25
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $32.44 / $90.30 / $162.00	Professional	50	$32.44	$90.30	$162.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.14 / $25.96 / $69.94	Professional	TC	$19.14	$25.96	$69.94
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $24.74 / $32.86 / $45.55	Professional		$24.74	$32.86	$45.55
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.60 / $8.44 / $12.37	Professional	26	$6.60	$8.44	$12.37
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $38.52 / $50.61 / $57.68	Professional	50	$38.52	$50.61	$57.68
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $21.85 / $30.81 / $34.83	Professional	TC	$21.85	$30.81	$34.83
BCBS Facility/Professional Facility Modifier Low / Median / High Price $66.17 / $121.14 / $468.71	Facility		$66.17	$121.14	$468.71
BCBS Facility/Professional Professional Modifier Low / Median / High Price $11.47 / $40.22 / $70.78	Professional		$11.47	$40.22	$70.78
Cigna Facility/Professional Facility Modifier Low / Median / High Price $33.44 / $73.93 / $206.41	Facility		$33.44	$73.93	$206.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $27.29 / $44.75 / $65.38	Professional		$27.29	$44.75	$65.38
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.93 / $12.37 / $19.86	Professional	26	$7.93	$12.37	$19.86
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $39.20 / $39.20 / $44.46	Professional	50	$39.20	$39.20	$44.46
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.67 / $32.29 / $48.25	Professional	TC	$19.67	$32.29	$48.25
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $38.65 / $58.28 / $180.21	Professional		$38.65	$58.28	$180.21
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.41 / $14.67 / $69.86	Professional	26	$10.41	$14.67	$69.86
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $26.08 / $38.70 / $116.56	Professional	TC	$26.08	$38.70	$116.56
Hally Health Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $100.00 / $100.00	Facility		$100.00	$100.00	$100.00
Hally Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	26	$100.00	$100.00	$100.00
Hally Health Facility/Professional Facility Modifier TC Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	TC	$100.00	$100.00	$100.00
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $40.95 / $41.65 / $45.45	Professional		$40.95	$41.65	$45.45
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.93 / $11.22 / $11.91	Professional	26	$10.93	$11.22	$11.91
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $29.73 / $30.72 / $33.54	Professional	TC	$29.73	$30.72	$33.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $12.46 / $32.34 / $47.55	Professional		$12.46	$32.34	$47.55
United Facility/Professional Professional Modifier Low / Median / High Price $30.16 / $39.90 / $63.22	Professional		$30.16	$39.90	$63.22
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.25 / $11.69 / $18.02	Professional	26	$9.25	$11.69	$18.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.17 / $28.59 / $44.88	Professional	TC	$21.17	$28.59	$44.88