Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $37.57 / $273.56 / $468.17	Facility		$37.57	$273.56	$468.17
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.14 / $12.06 / $13.61	Facility	26	$7.14	$12.06	$13.61
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $19.03 / $31.00 / $732.16	Facility	TC	$19.03	$31.00	$732.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $18.12 / $31.37 / $79.28	Professional		$18.12	$31.37	$79.28
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.74 / $9.65 / $39.29	Professional	26	$6.74	$9.65	$39.29
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $28.83 / $94.89 / $109.72	Professional	50	$28.83	$94.89	$109.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.72 / $21.35 / $39.92	Professional	TC	$17.72	$21.35	$39.92
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $17.54 / $27.80 / $35.86	Professional		$17.54	$27.80	$35.86
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.82 / $8.18 / $11.04	Professional	26	$5.82	$8.18	$11.04
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $17.48 / $24.64 / $25.19	Professional	TC	$17.48	$24.64	$25.19
BCBS Facility/Professional Facility Modifier Low / Median / High Price $56.52 / $103.95 / $294.06	Facility		$56.52	$103.95	$294.06
BCBS Facility/Professional Professional Modifier Low / Median / High Price $10.24 / $34.13 / $60.04	Professional		$10.24	$34.13	$60.04
Cigna Facility/Professional Facility Modifier Low / Median / High Price $32.84 / $62.86 / $172.00	Facility		$32.84	$62.86	$172.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $23.88 / $38.85 / $55.71	Professional		$23.88	$38.85	$55.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.62 / $10.78 / $16.97	Professional	26	$6.62	$10.78	$16.97
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $35.11 / $35.11 / $39.76	Professional	50	$35.11	$35.11	$39.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.30 / $27.76 / $40.86	Professional	TC	$17.30	$27.76	$40.86
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $33.86 / $48.82 / $128.90	Professional		$33.86	$48.82	$128.90
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.80 / $13.74 / $51.37	Professional	26	$9.80	$13.74	$51.37
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $23.65 / $33.29 / $72.77	Professional	TC	$23.65	$33.29	$72.77
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 $34.74 / $35.18 / $38.58	Professional		$34.74	$35.18	$38.58
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.69 / $10.00 / $10.63	Professional	26	$9.69	$10.00	$10.63
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $24.74 / $25.49 / $27.95	Professional	TC	$24.74	$25.49	$27.95
Molina Facility/Professional Professional Modifier Low / Median / High Price $11.12 / $32.34 / $40.36	Professional		$11.12	$32.34	$40.36
United Facility/Professional Facility Modifier Low / Median / High Price $8.61 / $27.67 / $104.26	Facility		$8.61	$27.67	$104.26
United Facility/Professional Professional Modifier Low / Median / High Price $27.38 / $35.22 / $55.04	Professional		$27.38	$35.22	$55.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.84 / $10.24 / $16.37	Professional	26	$7.84	$10.24	$16.37
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.17 / $26.10 / $37.51	Professional	TC	$19.17	$26.10	$37.51