Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $67.86 / $260.51 / $631.62	Facility		$67.86	$260.51	$631.62
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.50 / $13.48 / $18.92	Facility	26	$9.50	$13.48	$18.92
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $34.61 / $76.06 / $328.14	Facility	TC	$34.61	$76.06	$328.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $17.14 / $48.13 / $139.44	Professional		$17.14	$48.13	$139.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.60 / $12.72 / $51.85	Professional	26	$9.60	$12.72	$51.85
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $46.08 / $46.08 / $629.00	Professional	50	$46.08	$46.08	$629.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.55 / $34.61 / $71.17	Professional	TC	$27.55	$34.61	$71.17
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $33.79 / $41.39 / $58.04	Professional		$33.79	$41.39	$58.04
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.77 / $9.11 / $14.58	Professional	26	$7.77	$9.11	$14.58
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $29.64 / $42.85 / $50.02	Professional	TC	$29.64	$42.85	$50.02
BCBS Facility/Professional Facility Modifier Low / Median / High Price $77.31 / $134.16 / $518.71	Facility		$77.31	$134.16	$518.71
BCBS Facility/Professional Professional Modifier Low / Median / High Price $13.51 / $55.08 / $105.58	Professional		$13.51	$55.08	$105.58
Cigna Facility/Professional Facility Modifier Low / Median / High Price $48.04 / $99.87 / $251.63	Facility		$48.04	$99.87	$251.63
Cigna Facility/Professional Professional Modifier Low / Median / High Price $36.01 / $58.84 / $89.48	Professional		$36.01	$58.84	$89.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.08 / $14.58 / $22.39	Professional	26	$9.08	$14.58	$22.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.82 / $44.46 / $69.29	Professional	TC	$27.82	$44.46	$69.29
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $54.97 / $81.92 / $212.16	Professional		$54.97	$81.92	$212.16
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.88 / $16.35 / $56.50	Professional	26	$11.88	$16.35	$56.50
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $41.95 / $59.22 / $153.08	Professional	TC	$41.95	$59.22	$153.08
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 $56.04 / $57.42 / $62.21	Professional		$56.04	$57.42	$62.21
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.93 / $13.01 / $14.04	Professional	26	$11.93	$13.01	$14.04
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $42.77 / $44.41 / $48.17	Professional	TC	$42.77	$44.41	$48.17
Molina Facility/Professional Professional Modifier Low / Median / High Price $14.69 / $32.34 / $65.08	Professional		$14.69	$32.34	$65.08
United Facility/Professional Professional Modifier Low / Median / High Price $41.25 / $54.64 / $84.48	Professional		$41.25	$54.64	$84.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.24 / $14.72 / $21.62	Professional	26	$11.24	$14.72	$21.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $29.60 / $41.14 / $63.24	Professional	TC	$29.60	$41.14	$63.24