Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $39.81 / $239.88 / $436.52	Facility		$39.81	$239.88	$436.52
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.08 / $11.22 / $24.55	Facility	26	$7.08	$11.22	$24.55
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $19.95 / $34.67 / $102.33	Facility	TC	$19.95	$34.67	$102.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $12.88 / $36.31 / $112.20	Professional		$12.88	$36.31	$112.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $13.80 / $39.81	Professional	26	$7.08	$13.80	$39.81
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $48.98 / $104.71 / $251.19	Professional	50	$48.98	$104.71	$251.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $26.30 / $53.70	Professional	TC	$16.98	$26.30	$53.70
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $17.78 / $21.88 / $39.81	Professional		$17.78	$21.88	$39.81
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.89 / $7.59 / $11.22	Professional	26	$5.89	$7.59	$11.22
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $31.62 / $33.88 / $38.90	Professional	50	$31.62	$33.88	$38.90
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $15.49 / $19.05 / $28.18	Professional	TC	$15.49	$19.05	$28.18
BCBS Facility/Professional Facility Modifier Low / Median / High Price $56.23 / $112.20 / $269.15	Facility		$56.23	$112.20	$269.15
BCBS Facility/Professional Professional Modifier Low / Median / High Price $10.23 / $33.88 / $60.26	Professional		$10.23	$33.88	$60.26
Cigna Facility/Professional Facility Modifier Low / Median / High Price $20.89 / $47.86 / $131.83	Facility		$20.89	$47.86	$131.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $23.44 / $37.15 / $54.95	Professional		$23.44	$37.15	$54.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.76 / $10.72 / $15.85	Professional	26	$6.76	$10.72	$15.85
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $26.92 / $40.74	Professional	TC	$17.38	$26.92	$40.74
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $64.57 / $162.18	Professional		$33.88	$64.57	$162.18
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.77 / $16.22 / $54.95	Professional	26	$9.77	$16.22	$54.95
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $33.88 / $97.72	Professional	TC	$23.44	$33.88	$97.72
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 $34.67 / $35.48 / $38.90	Professional		$34.67	$35.48	$38.90
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.77 / $10.00 / $10.72	Professional	26	$9.77	$10.00	$10.72
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $25.70 / $28.18	Professional	TC	$24.55	$25.70	$28.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $33.11	Professional		$32.36	$33.11	$33.11
United Facility/Professional Facility Modifier Low / Median / High Price $19.05 / $74.13 / $229.09	Facility		$19.05	$74.13	$229.09
United Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $33.88 / $50.12	Professional		$25.70	$33.88	$50.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $9.55 / $15.14	Professional	26	$7.59	$9.55	$15.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $23.99 / $35.48	Professional	TC	$18.20	$23.99	$35.48