Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $39.60 / $305.88 / $508.00	Facility		$39.60	$305.88	$508.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.86 / $10.37 / $18.37	Facility	26	$6.86	$10.37	$18.37
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $19.78 / $31.92 / $403.20	Facility	TC	$19.78	$31.92	$403.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $14.52 / $32.34 / $78.17	Professional		$14.52	$32.34	$78.17
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.94 / $10.98 / $39.78	Professional	26	$6.94	$10.98	$39.78
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $90.00 / $95.74 / $103.55	Professional	50	$90.00	$95.74	$103.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.98 / $21.50 / $41.62	Professional	TC	$17.98	$21.50	$41.62
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $19.19 / $21.93 / $51.44	Professional		$19.19	$21.93	$51.44
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.65 / $7.34 / $10.60	Professional	26	$5.65	$7.34	$10.60
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $21.55 / $25.58 / $25.58	Professional	TC	$21.55	$25.58	$25.58
BCBS Facility/Professional Facility Modifier Low / Median / High Price $56.52 / $103.95 / $298.57	Facility		$56.52	$103.95	$298.57
BCBS Facility/Professional Professional Modifier Low / Median / High Price $9.82 / $34.13 / $60.04	Professional		$9.82	$34.13	$60.04
Cigna Facility/Professional Facility Modifier Low / Median / High Price $29.79 / $63.96 / $174.65	Facility		$29.79	$63.96	$174.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $23.60 / $38.58 / $55.50	Professional		$23.60	$38.58	$55.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.52 / $10.60 / $16.44	Professional	26	$6.52	$10.60	$16.44
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $36.49 / $36.49 / $41.33	Professional	50	$36.49	$36.49	$41.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.07 / $28.18 / $40.82	Professional	TC	$17.07	$28.18	$40.82
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $34.07 / $49.04 / $142.80	Professional		$34.07	$49.04	$142.80
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.27 / $13.30 / $53.54	Professional	26	$9.27	$13.30	$53.54
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $24.01 / $34.58 / $90.51	Professional	TC	$24.01	$34.58	$90.51
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 $9.27 / $9.61 / $10.21	Professional	26	$9.27	$9.61	$10.21
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.13 / $25.90 / $28.38	Professional	TC	$25.13	$25.90	$28.38
Molina Facility/Professional Professional Modifier Low / Median / High Price $10.68 / $32.34 / $40.36	Professional		$10.68	$32.34	$40.36
United Facility/Professional Facility Modifier Low / Median / High Price $99.68 / $99.68 / $104.26	Facility		$99.68	$99.68	$104.26
United Facility/Professional Professional Modifier Low / Median / High Price $27.77 / $40.07 / $81.01	Professional		$27.77	$40.07	$81.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.07 / $10.40 / $16.92	Professional	26	$8.07	$10.40	$16.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.86 / $25.96 / $38.40	Professional	TC	$18.86	$25.96	$38.40