Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $39.88 / $264.69 / $492.00	Facility		$39.88	$264.69	$492.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.36 / $12.06 / $14.21	Facility	26	$7.36	$12.06	$14.21
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $21.98 / $31.11 / $222.60	Facility	TC	$21.98	$31.11	$222.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $15.58 / $30.54 / $78.61	Professional		$15.58	$30.54	$78.61
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.03 / $9.97 / $33.00	Professional	26	$7.03	$9.97	$33.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $33.00 / $96.04 / $276.00	Professional	50	$33.00	$96.04	$276.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $11.53 / $15.03 / $23.33	Professional	52	$11.53	$15.03	$23.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.89 / $22.33 / $45.77	Professional	TC	$17.89	$22.33	$45.77
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $18.71 / $27.35 / $54.89	Professional		$18.71	$27.35	$54.89
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $2.73 / $8.18 / $16.38	Professional	26	$2.73	$8.18	$16.38
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $35.08 / $38.77 / $38.77	Professional	50	$35.08	$38.77	$38.77
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $16.12 / $16.12 / $32.04	Professional	TC	$16.12	$16.12	$32.04
BCBS Facility/Professional Facility Modifier Low / Median / High Price $56.52 / $103.95 / $321.25	Facility		$56.52	$103.95	$321.25
BCBS Facility/Professional Professional Modifier Low / Median / High Price $10.24 / $36.39 / $64.02	Professional		$10.24	$36.39	$64.02
Cigna Facility/Professional Facility Modifier Low / Median / High Price $30.39 / $68.38 / $187.88	Facility		$30.39	$68.38	$187.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $24.64 / $39.79 / $59.22	Professional		$24.64	$39.79	$59.22
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.80 / $11.04 / $17.07	Professional	26	$6.80	$11.04	$17.07
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $37.85 / $37.85 / $42.89	Professional	50	$37.85	$37.85	$42.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.04 / $28.35 / $43.92	Professional	TC	$18.04	$28.35	$43.92
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $34.90 / $51.28 / $109.55	Professional		$34.90	$51.28	$109.55
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.80 / $13.84 / $50.46	Professional	26	$9.80	$13.84	$50.46
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $23.62 / $35.24 / $71.34	Professional	TC	$23.62	$35.24	$71.34
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 $37.04 / $37.60 / $41.17	Professional		$37.04	$37.60	$41.17
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 $27.04 / $27.91 / $30.54	Professional	TC	$27.04	$27.91	$30.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $11.12 / $32.34 / $43.07	Professional		$11.12	$32.34	$43.07
United Facility/Professional Facility Modifier Low / Median / High Price $128.26 / $128.26 / $180.02	Facility		$128.26	$128.26	$180.02
United Facility/Professional Professional Modifier Low / Median / High Price $27.61 / $37.94 / $57.89	Professional		$27.61	$37.94	$57.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.22 / $10.24 / $16.92	Professional	26	$8.22	$10.24	$16.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.79 / $26.29 / $41.04	Professional	TC	$19.79	$26.29	$41.04