Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $44.48 / $314.94 / $524.16	Facility		$44.48	$314.94	$524.16
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.44 / $11.21 / $25.53	Facility	26	$7.44	$11.21	$25.53
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $23.28 / $39.50 / $403.20	Facility	TC	$23.28	$39.50	$403.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $14.34 / $37.85 / $120.65	Professional		$14.34	$37.85	$120.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.36 / $11.81 / $41.04	Professional	26	$7.36	$11.81	$41.04
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $29.97 / $79.14 / $119.13	Professional	50	$29.97	$79.14	$119.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $26.63 / $71.08	Professional	TC	$20.42	$26.63	$71.08
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $21.33 / $28.51 / $42.96	Professional		$21.33	$28.51	$42.96
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.12 / $7.94 / $11.91	Professional	26	$6.12	$7.94	$11.91
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $36.29 / $36.29 / $40.57	Professional	50	$36.29	$36.29	$40.57
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $24.23 / $29.20 / $33.04	Professional	TC	$24.23	$29.20	$33.04
BCBS Facility/Professional Facility Modifier Low / Median / High Price $66.88 / $124.55 / $334.90	Facility		$66.88	$124.55	$334.90
BCBS Facility/Professional Professional Modifier Low / Median / High Price $10.65 / $37.94 / $66.73	Professional		$10.65	$37.94	$66.73
Cigna Facility/Professional Facility Modifier Low / Median / High Price $38.31 / $69.50 / $195.82	Facility		$38.31	$69.50	$195.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $27.30 / $44.46 / $66.29	Professional		$27.30	$44.46	$66.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $11.48 / $17.80	Professional	26	$7.08	$11.48	$17.80
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $38.75 / $38.75 / $43.94	Professional	50	$38.75	$38.75	$43.94
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.22 / $32.06 / $47.69	Professional	TC	$20.22	$32.06	$47.69
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $37.69 / $56.07 / $160.97	Professional		$37.69	$56.07	$160.97
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.21 / $14.42 / $59.58	Professional	26	$10.21	$14.42	$59.58
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $27.04 / $38.08 / $114.84	Professional	TC	$27.04	$38.08	$114.84
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 $38.61 / $39.22 / $42.87	Professional		$38.61	$39.22	$42.87
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.10 / $10.41 / $11.06	Professional	26	$10.10	$10.41	$11.06
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $28.20 / $29.12 / $31.82	Professional	TC	$28.20	$29.12	$31.82
Molina Facility/Professional Professional Modifier Low / Median / High Price $11.57 / $32.34 / $44.85	Professional		$11.57	$32.34	$44.85
United Facility/Professional Professional Modifier Low / Median / High Price $30.68 / $40.78 / $60.16	Professional		$30.68	$40.78	$60.16
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.57 / $10.90 / $17.01	Professional	26	$8.57	$10.90	$17.01
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.12 / $29.45 / $43.61	Professional	TC	$22.12	$29.45	$43.61