Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $38.90 / $208.93 / $416.87	Facility		$38.90	$208.93	$416.87
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.08 / $10.72 / $24.55	Facility	26	$7.08	$10.72	$24.55
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $21.88 / $38.90 / $223.87	Facility	TC	$21.88	$38.90	$223.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $13.18 / $35.48 / $134.90	Professional		$13.18	$35.48	$134.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $15.85 / $47.86	Professional	26	$7.08	$15.85	$47.86
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $39.81 / $89.13 / $199.53	Professional	50	$39.81	$89.13	$199.53
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $10.72 / $22.91 / $173.78	Professional	52	$10.72	$22.91	$173.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $26.92 / $63.10	Professional	TC	$17.78	$26.92	$63.10
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $18.20 / $22.91 / $43.65	Professional		$18.20	$22.91	$43.65
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.89 / $7.59 / $12.88	Professional	26	$5.89	$7.59	$12.88
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $28.84 / $35.48 / $45.71	Professional	50	$28.84	$35.48	$45.71
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $14.45 / $35.48 / $43.65	Professional	TC	$14.45	$35.48	$43.65
BCBS Facility/Professional Facility Modifier Low / Median / High Price $56.23 / $131.83 / $275.42	Facility		$56.23	$131.83	$275.42
BCBS Facility/Professional Professional Modifier Low / Median / High Price $10.23 / $36.31 / $64.57	Professional		$10.23	$36.31	$64.57
Cigna Facility/Professional Facility Modifier Low / Median / High Price $22.39 / $52.48 / $134.90	Facility		$22.39	$52.48	$134.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $38.02 / $57.54	Professional		$24.55	$38.02	$57.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.92 / $10.96 / $16.22	Professional	26	$6.92	$10.96	$16.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $27.54 / $43.65	Professional	TC	$18.20	$27.54	$43.65
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $57.54 / $125.89	Professional		$34.67	$57.54	$125.89
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.77 / $16.22 / $66.07	Professional	26	$9.77	$16.22	$66.07
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $35.48 / $74.13	Professional	TC	$23.44	$35.48	$74.13
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 $37.15 / $38.02 / $40.74	Professional		$37.15	$38.02	$40.74
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.77 / $10.00 / $10.72	Professional	26	$9.77	$10.00	$10.72
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $28.18 / $30.20	Professional	TC	$26.92	$28.18	$30.20
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 $17.78 / $89.13 / $275.42	Facility		$17.78	$89.13	$275.42
United Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $34.67 / $52.48	Professional		$26.30	$34.67	$52.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $9.77 / $15.49	Professional	26	$7.76	$9.77	$15.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $24.55 / $38.02	Professional	TC	$18.20	$24.55	$38.02