Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $42.76 / $282.80 / $556.00	Facility		$42.76	$282.80	$556.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.36 / $12.06 / $14.76	Facility	26	$7.36	$12.06	$14.76
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $23.72 / $35.54 / $95.34	Facility	TC	$23.72	$35.54	$95.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $18.10 / $36.65 / $104.50	Professional		$18.10	$36.65	$104.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.19 / $10.63 / $42.40	Professional	26	$7.19	$10.63	$42.40
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $52.88 / $110.33 / $324.00	Professional	50	$52.88	$110.33	$324.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $11.83 / $16.29 / $29.11	Professional	52	$11.83	$16.29	$29.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.07 / $24.85 / $44.36	Professional	TC	$20.07	$24.85	$44.36
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $22.58 / $24.47 / $31.90	Professional		$22.58	$24.47	$31.90
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.83 / $8.90 / $11.04	Professional	26	$5.83	$8.90	$11.04
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $18.82 / $18.82 / $18.82	Professional	TC	$18.82	$18.82	$18.82
BCBS Facility/Professional Facility Modifier Low / Median / High Price $57.90 / $109.72 / $357.58	Facility		$57.90	$109.72	$357.58
BCBS Facility/Professional Professional Modifier Low / Median / High Price $10.24 / $39.03 / $68.66	Professional		$10.24	$39.03	$68.66
Cigna Facility/Professional Facility Modifier Low / Median / High Price $35.27 / $76.14 / $206.41	Facility		$35.27	$76.14	$206.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.80 / $41.39 / $63.55	Professional		$26.80	$41.39	$63.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.06 / $11.04 / $17.64	Professional	26	$7.06	$11.04	$17.64
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $41.47 / $41.47 / $47.09	Professional	50	$41.47	$41.47	$47.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $30.96 / $48.25	Professional	TC	$19.50	$30.96	$48.25
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $37.38 / $54.37 / $139.72	Professional		$37.38	$54.37	$139.72
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.80 / $13.84 / $52.28	Professional	26	$9.80	$13.84	$52.28
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.16 / $38.70 / $87.18	Professional	TC	$25.16	$38.70	$87.18
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 $39.72 / $40.40 / $44.17	Professional		$39.72	$40.40	$44.17
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 $29.73 / $30.72 / $33.54	Professional	TC	$29.73	$30.72	$33.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $11.12 / $32.34 / $46.21	Professional		$11.12	$32.34	$46.21
United Facility/Professional Professional Modifier Low / Median / High Price $29.67 / $40.11 / $61.49	Professional		$29.67	$40.11	$61.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.23 / $10.72 / $16.92	Professional	26	$8.23	$10.72	$16.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.90 / $28.75 / $45.40	Professional	TC	$20.90	$28.75	$45.40