Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $49.35 / $307.00 / $532.00	Facility		$49.35	$307.00	$532.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.74 / $11.66 / $15.97	Facility	26	$7.74	$11.66	$15.97
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $25.22 / $41.57 / $479.32	Facility	TC	$25.22	$41.57	$479.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $16.07 / $35.69 / $119.80	Professional		$16.07	$35.69	$119.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.82 / $10.57 / $47.60	Professional	26	$7.82	$10.57	$47.60
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $116.04 / $127.28 / $620.00	Professional	50	$116.04	$127.28	$620.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.96 / $25.80 / $50.31	Professional	TC	$20.96	$25.80	$50.31
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $23.25 / $32.08 / $34.70	Professional		$23.25	$32.08	$34.70
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.29 / $8.31 / $11.92	Professional	26	$6.29	$8.31	$11.92
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $37.06 / $37.06 / $37.06	Professional	TC	$37.06	$37.06	$37.06
BCBS Facility/Professional Facility Modifier Low / Median / High Price $61.23 / $113.93 / $386.53	Facility		$61.23	$113.93	$386.53
BCBS Facility/Professional Professional Modifier Low / Median / High Price $11.05 / $39.44 / $79.29	Professional		$11.05	$39.44	$79.29
Cigna Facility/Professional Facility Modifier Low / Median / High Price $36.17 / $79.44 / $217.00	Facility		$36.17	$79.44	$217.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.00 / $45.51 / $67.23	Professional		$28.00	$45.51	$67.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.38 / $12.06 / $18.60	Professional	26	$7.38	$12.06	$18.60
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 $21.04 / $33.67 / $50.72	Professional	TC	$21.04	$33.67	$50.72
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $41.28 / $61.68 / $177.23	Professional		$41.28	$61.68	$177.23
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.71 / $13.33 / $46.23	Professional	26	$9.71	$13.33	$46.23
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $29.71 / $40.63 / $95.87	Professional	TC	$29.71	$40.63	$95.87
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 $42.09 / $42.86 / $46.75	Professional		$42.09	$42.86	$46.75
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.76 / $10.53 / $11.48	Professional	26	$9.76	$10.53	$11.48
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $29.98 / $31.27 / $35.27	Professional	TC	$29.98	$31.27	$35.27
Molina Facility/Professional Professional Modifier Low / Median / High Price $12.01 / $32.34 / $48.91	Professional		$12.01	$32.34	$48.91
United Facility/Professional Professional Modifier Low / Median / High Price $31.51 / $42.74 / $65.91	Professional		$31.51	$42.74	$65.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.19 / $11.83 / $17.50	Professional	26	$9.19	$11.83	$17.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.48 / $31.36 / $47.49	Professional	TC	$22.48	$31.36	$47.49