Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $53.70 / $346.74 / $758.58	Facility		$53.70	$346.74	$758.58
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.55 / $15.85 / $32.36	Facility	26	$9.55	$15.85	$32.36
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $28.84 / $51.29 / $288.40	Facility	TC	$28.84	$51.29	$288.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $54.95 / $162.18	Professional		$33.88	$54.95	$162.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $15.85 / $44.67	Professional	26	$8.91	$15.85	$44.67
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $26.92 / $120.23 / $204.17	Professional	50	$26.92	$120.23	$204.17
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $17.78 / $147.91 / $162.18	Professional	52	$17.78	$147.91	$162.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $33.11 / $69.18	Professional	TC	$23.99	$33.11	$69.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $30.90 / $47.86	Professional		$26.30	$30.90	$47.86
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $8.91 / $15.85	Professional	26	$7.94	$8.91	$15.85
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $14.13 / $14.13 / $14.13	Professional	52	$14.13	$14.13	$14.13
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $23.44 / $38.90	Professional	TC	$19.50	$23.44	$38.90
BCBS Facility/Professional Facility Modifier Low / Median / High Price $81.28 / $147.91 / $371.54	Facility		$81.28	$147.91	$371.54
BCBS Facility/Professional Professional Modifier Low / Median / High Price $13.49 / $47.86 / $91.20	Professional		$13.49	$47.86	$91.20
Cigna Facility/Professional Facility Modifier Low / Median / High Price $29.51 / $67.61 / $158.49	Facility		$29.51	$67.61	$158.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $52.48 / $77.62	Professional		$33.11	$52.48	$77.62
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $14.79 / $22.39	Professional	26	$9.12	$14.79	$22.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $37.15 / $56.23	Professional	TC	$23.99	$37.15	$56.23
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $117.49 / $245.47	Professional		$48.98	$117.49	$245.47
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $26.92 / $104.71	Professional	26	$12.88	$26.92	$104.71
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $45.71 / $147.91	Professional	TC	$32.36	$45.71	$147.91
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 $48.98 / $50.12 / $53.70	Professional		$48.98	$50.12	$53.70
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $13.18 / $14.13	Professional	26	$12.88	$13.18	$14.13
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $35.48 / $39.81	Professional	TC	$33.88	$35.48	$39.81
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 $28.18 / $89.13 / $275.42	Facility		$28.18	$89.13	$275.42
United Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $47.86 / $70.79	Professional		$37.15	$47.86	$70.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $13.49 / $20.89	Professional	26	$10.96	$13.49	$20.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $33.88 / $50.12	Professional	TC	$25.70	$33.88	$50.12