Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $52.51 / $373.31 / $755.79	Facility		$52.51	$373.31	$755.79
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.50 / $16.11 / $18.92	Facility	26	$9.50	$16.11	$18.92
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $29.26 / $45.18 / $312.08	Facility	TC	$29.26	$45.18	$312.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $34.90 / $43.11 / $89.35	Professional		$34.90	$43.11	$89.35
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.50 / $12.06 / $46.82	Professional	26	$9.50	$12.06	$46.82
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $38.29 / $38.29 / $38.29	Professional	50	$38.29	$38.29	$38.29
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $38.29 / $148.75 / $163.63	Professional	52	$38.29	$148.75	$163.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.42 / $29.26 / $53.05	Professional	TC	$25.42	$29.26	$53.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $26.80 / $37.25 / $41.83	Professional		$26.80	$37.25	$41.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.77 / $9.11 / $14.47	Professional	26	$7.77	$9.11	$14.47
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $35.49 / $35.49 / $35.49	Professional	TC	$35.49	$35.49	$35.49
BCBS Facility/Professional Facility Modifier Low / Median / High Price $80.03 / $142.57 / $438.47	Facility		$80.03	$142.57	$438.47
BCBS Facility/Professional Professional Modifier Low / Median / High Price $13.51 / $47.92 / $91.85	Professional		$13.51	$47.92	$91.85
Cigna Facility/Professional Facility Modifier Low / Median / High Price $43.97 / $89.41 / $246.12	Facility		$43.97	$89.41	$246.12
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.97 / $53.20 / $80.94	Professional		$32.97	$53.20	$80.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.10 / $14.74 / $22.77	Professional	26	$9.10	$14.74	$22.77
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $49.64 / $49.64 / $56.50	Professional	50	$49.64	$49.64	$56.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.95 / $39.38 / $57.53	Professional	TC	$23.95	$39.38	$57.53
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $47.83 / $71.45 / $226.59	Professional		$47.83	$71.45	$226.59
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.78 / $18.39 / $71.91	Professional	26	$12.78	$18.39	$71.91
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $33.85 / $46.16 / $102.64	Professional	TC	$33.85	$46.16	$102.64
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 $48.76 / $49.78 / $54.03	Professional		$48.76	$49.78	$54.03
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.01 / $13.29 / $14.04	Professional	26	$13.01	$13.29	$14.04
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $34.00 / $35.47 / $40.00	Professional	TC	$34.00	$35.47	$40.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $14.69 / $32.34 / $56.52	Professional		$14.69	$32.34	$56.52
United Facility/Professional Professional Modifier Low / Median / High Price $38.22 / $48.74 / $75.78	Professional		$38.22	$48.74	$75.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.23 / $14.49 / $22.10	Professional	26	$11.23	$14.49	$22.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.65 / $36.76 / $56.11	Professional	TC	$26.65	$36.76	$56.11