Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $58.56 / $331.76 / $631.79	Facility		$58.56	$331.76	$631.79
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.44 / $11.16 / $14.81	Facility	26	$7.44	$11.16	$14.81
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $27.37 / $91.79 / $430.50	Facility	TC	$27.37	$91.79	$430.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $14.29 / $43.70 / $134.94	Professional		$14.29	$43.70	$134.94
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.44 / $12.75 / $49.78	Professional	26	$7.44	$12.75	$49.78
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $23.83 / $105.33 / $144.26	Professional	50	$23.83	$105.33	$144.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.64 / $28.24 / $69.16	Professional	TC	$21.64	$28.24	$69.16
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $26.54 / $32.47 / $45.46	Professional		$26.54	$32.47	$45.46
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.16 / $7.98 / $11.82	Professional	26	$6.16	$7.98	$11.82
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $39.79 / $46.27 / $54.44	Professional	50	$39.79	$46.27	$54.44
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $24.69 / $34.84 / $39.29	Professional	TC	$24.69	$34.84	$39.29
BCBS Facility/Professional Facility Modifier Low / Median / High Price $60.61 / $114.20 / $393.80	Facility		$60.61	$114.20	$393.80
BCBS Facility/Professional Professional Modifier Low / Median / High Price $10.65 / $43.21 / $76.02	Professional		$10.65	$43.21	$76.02
Cigna Facility/Professional Facility Modifier Low / Median / High Price $37.71 / $81.66 / $232.88	Facility		$37.71	$81.66	$232.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.29 / $44.03 / $67.70	Professional		$28.29	$44.03	$67.70
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 $43.28 / $43.28 / $49.18	Professional	50	$43.28	$43.28	$49.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.79 / $34.47 / $54.44	Professional	TC	$20.79	$34.47	$54.44
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $41.38 / $60.19 / $159.24	Professional		$41.38	$60.19	$159.24
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 $29.11 / $45.44 / $112.79	Professional	TC	$29.11	$45.44	$112.79
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 $43.98 / $44.85 / $48.91	Professional		$43.98	$44.85	$48.91
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 $33.57 / $34.75 / $37.84	Professional	TC	$33.57	$34.75	$37.84
Molina Facility/Professional Professional Modifier Low / Median / High Price $11.57 / $32.34 / $51.16	Professional		$11.57	$32.34	$51.16
United Facility/Professional Facility Modifier Low / Median / High Price $8.98 / $30.54 / $104.26	Facility		$8.98	$30.54	$104.26
United Facility/Professional Professional Modifier Low / Median / High Price $31.64 / $42.44 / $66.59	Professional		$31.64	$42.44	$66.59
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.57 / $10.86 / $17.59	Professional	26	$8.57	$10.86	$17.59
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $31.00 / $48.72	Professional	TC	$22.39	$31.00	$48.72