Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $58.64 / $318.31 / $613.66	Facility		$58.64	$318.31	$613.66
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.01 / $11.36 / $15.97	Facility	26	$8.01	$11.36	$15.97
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $30.21 / $116.28 / $491.36	Facility	TC	$30.21	$116.28	$491.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $16.14 / $49.64 / $151.19	Professional		$16.14	$49.64	$151.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.56 / $13.69 / $55.78	Professional	26	$8.56	$13.69	$55.78
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $18.86 / $114.54 / $195.27	Professional	50	$18.86	$114.54	$195.27
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $15.13 / $19.43 / $28.64	Professional	52	$15.13	$19.43	$28.64
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.44 / $31.95 / $82.04	Professional	TC	$24.44	$31.95	$82.04
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $28.92 / $36.56 / $71.12	Professional		$28.92	$36.56	$71.12
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.60 / $8.56 / $12.84	Professional	26	$6.60	$8.56	$12.84
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $45.13 / $45.34 / $57.81	Professional	50	$45.13	$45.34	$57.81
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $26.96 / $36.65 / $38.11	Professional	TC	$26.96	$36.65	$38.11
BCBS Facility/Professional Facility Modifier Low / Median / High Price $66.88 / $126.42 / $577.02	Facility		$66.88	$126.42	$577.02
BCBS Facility/Professional Professional Modifier Low / Median / High Price $11.47 / $47.02 / $90.13	Professional		$11.47	$47.02	$90.13
Cigna Facility/Professional Facility Modifier Low / Median / High Price $45.00 / $88.86 / $251.63	Facility		$45.00	$88.86	$251.63
Cigna Facility/Professional Professional Modifier Low / Median / High Price $31.47 / $48.56 / $73.70	Professional		$31.47	$48.56	$73.70
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.93 / $12.37 / $19.86	Professional	26	$7.93	$12.37	$19.86
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $48.26 / $48.26 / $54.93	Professional	50	$48.26	$48.26	$54.93
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.23 / $38.04 / $59.39	Professional	TC	$23.23	$38.04	$59.39
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $45.01 / $65.47 / $203.00	Professional		$45.01	$65.47	$203.00
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.99 / $15.53 / $63.84	Professional	26	$10.99	$15.53	$63.84
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $33.40 / $47.91 / $135.02	Professional	TC	$33.40	$47.91	$135.02
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 $47.85 / $48.89 / $53.20	Professional		$47.85	$48.89	$53.20
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.93 / $11.22 / $11.91	Professional	26	$10.93	$11.22	$11.91
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $36.63 / $37.97 / $41.29	Professional	TC	$36.63	$37.97	$41.29
Molina Facility/Professional Professional Modifier Low / Median / High Price $12.46 / $32.34 / $55.65	Professional		$12.46	$32.34	$55.65
United Facility/Professional Professional Modifier Low / Median / High Price $35.04 / $48.39 / $74.63	Professional		$35.04	$48.39	$74.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.26 / $12.29 / $18.55	Professional	26	$9.26	$12.29	$18.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.57 / $35.36 / $55.32	Professional	TC	$25.57	$35.36	$55.32