Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $49.75 / $305.08 / $572.16	Facility		$49.75	$305.08	$572.16
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.13 / $10.76 / $14.21	Facility	26	$7.13	$10.76	$14.21
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $25.17 / $40.04 / $461.97	Facility	TC	$25.17	$40.04	$461.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $14.76 / $39.72 / $108.14	Professional		$14.76	$39.72	$108.14
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.49 / $11.37 / $49.60	Professional	26	$7.49	$11.37	$49.60
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $28.96 / $78.00 / $122.64	Professional	50	$28.96	$78.00	$122.64
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $12.64 / $16.45 / $24.87	Professional	52	$12.64	$16.45	$24.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.46 / $25.29 / $61.29	Professional	TC	$19.46	$25.29	$61.29
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $22.80 / $26.73 / $33.09	Professional		$22.80	$26.73	$33.09
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.83 / $7.91 / $11.35	Professional	26	$5.83	$7.91	$11.35
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $37.75 / $48.33 / $48.33	Professional	50	$37.75	$48.33	$48.33
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $20.91 / $30.06 / $31.00	Professional	TC	$20.91	$30.06	$31.00
BCBS Facility/Professional Facility Modifier Low / Median / High Price $58.90 / $109.85 / $372.35	Facility		$58.90	$109.85	$372.35
BCBS Facility/Professional Professional Modifier Low / Median / High Price $10.24 / $39.40 / $75.54	Professional		$10.24	$39.40	$75.54
Cigna Facility/Professional Facility Modifier Low / Median / High Price $38.47 / $78.34 / $209.06	Facility		$38.47	$78.34	$209.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $27.00 / $42.89 / $64.17	Professional		$27.00	$42.89	$64.17
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.06 / $11.40 / $17.64	Professional	26	$7.06	$11.40	$17.64
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $41.91 / $41.91 / $47.61	Professional	50	$41.91	$41.91	$47.61
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.12 / $31.27 / $48.87	Professional	TC	$19.12	$31.27	$48.87
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $37.74 / $55.53 / $146.91	Professional		$37.74	$55.53	$146.91
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.24 / $13.26 / $58.69	Professional	26	$9.24	$13.26	$58.69
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $26.79 / $38.59 / $90.83	Professional	TC	$26.79	$38.59	$90.83
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 $40.11 / $40.81 / $44.60	Professional		$40.11	$40.81	$44.60
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.69 / $10.00 / $10.63	Professional	26	$9.69	$10.00	$10.63
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $30.11 / $31.12 / $33.97	Professional	TC	$30.11	$31.12	$33.97
Molina Facility/Professional Professional Modifier Low / Median / High Price $11.12 / $32.34 / $46.66	Professional		$11.12	$32.34	$46.66
United Facility/Professional Facility Modifier Low / Median / High Price $99.68 / $99.68 / $104.26	Facility		$99.68	$99.68	$104.26
United Facility/Professional Professional Modifier Low / Median / High Price $30.09 / $41.04 / $62.81	Professional		$30.09	$41.04	$62.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.66 / $11.88 / $25.45	Professional	26	$8.66	$11.88	$25.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.90 / $29.05 / $47.13	Professional	TC	$20.90	$29.05	$47.13