Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $39.81 / $288.40 / $512.86	Facility		$39.81	$288.40	$512.86
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.92 / $10.00 / $23.44	Facility	26	$6.92	$10.00	$23.44
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $19.95 / $36.31 / $363.08	Facility	TC	$19.95	$36.31	$363.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $10.47 / $32.36 / $109.65	Professional		$10.47	$32.36	$109.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $13.49 / $43.65	Professional	26	$7.08	$13.49	$43.65
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $33.11 / $79.43 / $251.19	Professional	50	$33.11	$79.43	$251.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $28.84 / $60.26	Professional	TC	$16.98	$28.84	$60.26
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $17.78 / $21.38 / $33.11	Professional		$17.78	$21.38	$33.11
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.75 / $6.92 / $10.96	Professional	26	$5.75	$6.92	$10.96
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $14.13 / $19.50 / $24.55	Professional	TC	$14.13	$19.50	$24.55
BCBS Facility/Professional Facility Modifier Low / Median / High Price $56.23 / $112.20 / $251.19	Facility		$56.23	$112.20	$251.19
BCBS Facility/Professional Professional Modifier Low / Median / High Price $9.77 / $33.88 / $60.26	Professional		$9.77	$33.88	$60.26
Cigna Facility/Professional Facility Modifier Low / Median / High Price $20.89 / $48.98 / $131.83	Facility		$20.89	$48.98	$131.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $23.44 / $37.15 / $53.70	Professional		$23.44	$37.15	$53.70
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.61 / $10.72 / $16.22	Professional	26	$6.61	$10.72	$16.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $26.30 / $40.74	Professional	TC	$17.38	$26.30	$40.74
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $66.07 / $144.54	Professional		$34.67	$66.07	$144.54
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $16.22 / $69.18	Professional	26	$9.33	$16.22	$69.18
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $34.67 / $102.33	Professional	TC	$23.99	$34.67	$102.33
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 $9.33 / $9.55 / $10.23	Professional	26	$9.33	$9.55	$10.23
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $25.70 / $28.18	Professional	TC	$25.12	$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 $17.38 / $74.13 / $229.09	Facility		$17.38	$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 $7.76 / $9.77 / $15.14	Professional	26	$7.76	$9.77	$15.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $23.99 / $35.48	Professional	TC	$17.78	$23.99	$35.48