Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $64.65 / $325.27 / $549.60	Facility		$64.65	$325.27	$549.60
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.44 / $10.81 / $14.81	Facility	26	$7.44	$10.81	$14.81
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $31.14 / $68.42 / $403.20	Facility	TC	$31.14	$68.42	$403.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $14.70 / $46.32 / $134.29	Professional		$14.70	$46.32	$134.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.63 / $12.84 / $51.19	Professional	26	$7.63	$12.84	$51.19
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $17.50 / $106.16 / $299.48	Professional	50	$17.50	$106.16	$299.48
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.37 / $33.99 / $82.14	Professional	TC	$25.37	$33.99	$82.14
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $27.63 / $37.13 / $44.84	Professional		$27.63	$37.13	$44.84
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.12 / $8.28 / $11.91	Professional	26	$6.12	$8.28	$11.91
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $44.07 / $44.07 / $45.84	Professional	50	$44.07	$44.07	$45.84
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $25.86 / $39.70 / $44.66	Professional	TC	$25.86	$39.70	$44.66
BCBS Facility/Professional Facility Modifier Low / Median / High Price $60.61 / $121.05 / $448.19	Facility		$60.61	$121.05	$448.19
BCBS Facility/Professional Professional Modifier Low / Median / High Price $10.65 / $47.73 / $83.97	Professional		$10.65	$47.73	$83.97
Cigna Facility/Professional Facility Modifier Low / Median / High Price $45.60 / $89.12 / $251.63	Facility		$45.60	$89.12	$251.63
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.64 / $49.18 / $74.86	Professional		$30.64	$49.18	$74.86
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 $47.36 / $47.36 / $53.88	Professional	50	$47.36	$47.36	$53.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.26 / $39.42 / $61.86	Professional	TC	$23.26	$39.42	$61.86
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $45.75 / $66.54 / $201.09	Professional		$45.75	$66.54	$201.09
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 $33.08 / $51.48 / $133.56	Professional	TC	$33.08	$51.48	$133.56
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 $48.58 / $49.69 / $54.07	Professional		$48.58	$49.69	$54.07
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 $38.17 / $39.57 / $43.00	Professional	TC	$38.17	$39.57	$43.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $11.57 / $32.34 / $56.56	Professional		$11.57	$32.34	$56.56
United Facility/Professional Professional Modifier Low / Median / High Price $33.63 / $44.95 / $72.70	Professional		$33.63	$44.95	$72.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.66 / $11.17 / $16.72	Professional	26	$8.66	$11.17	$16.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.45 / $35.69 / $57.16	Professional	TC	$25.45	$35.69	$57.16