Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $57.54 / $288.40 / $575.44	Facility		$57.54	$288.40	$575.44
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.94 / $11.48 / $27.54	Facility	26	$7.94	$11.48	$27.54
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $30.20 / $91.20 / $467.74	Facility	TC	$30.20	$91.20	$467.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $10.23 / $47.86 / $165.96	Professional		$10.23	$47.86	$165.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $16.22 / $53.70	Professional	26	$8.51	$16.22	$53.70
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $19.05 / $100.00 / $309.03	Professional	50	$19.05	$100.00	$309.03
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $33.11 / $33.11 / $33.11	Professional	52	$33.11	$33.11	$33.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $41.69 / $97.72	Professional	TC	$25.12	$41.69	$97.72
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $30.90 / $50.12	Professional		$26.30	$30.90	$50.12
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.76 / $9.12 / $13.80	Professional	26	$6.76	$9.12	$13.80
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $38.02 / $46.77 / $72.44	Professional	50	$38.02	$46.77	$72.44
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $28.84 / $50.12	Professional	TC	$20.42	$28.84	$50.12
BCBS Facility/Professional Facility Modifier Low / Median / High Price $74.13 / $125.89 / $478.63	Facility		$74.13	$125.89	$478.63
BCBS Facility/Professional Professional Modifier Low / Median / High Price $11.48 / $46.77 / $89.13	Professional		$11.48	$46.77	$89.13
Cigna Facility/Professional Facility Modifier Low / Median / High Price $30.90 / $63.10 / $144.54	Facility		$30.90	$63.10	$144.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $47.86 / $74.13	Professional		$31.62	$47.86	$74.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $12.59 / $19.50	Professional	26	$7.94	$12.59	$19.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $37.15 / $57.54	Professional	TC	$23.44	$37.15	$57.54
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $91.20 / $208.93	Professional		$44.67	$91.20	$208.93
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $18.20 / $95.50	Professional	26	$10.96	$18.20	$95.50
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $54.95 / $147.91	Professional	TC	$31.62	$54.95	$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 $47.86 / $48.98 / $53.70	Professional		$47.86	$48.98	$53.70
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $11.22 / $12.02	Professional	26	$10.96	$11.22	$12.02
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $38.02 / $41.69	Professional	TC	$36.31	$38.02	$41.69
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 $22.91 / $74.13 / $229.09	Facility		$22.91	$74.13	$229.09
United Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $44.67 / $67.61	Professional		$33.88	$44.67	$67.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $11.22 / $17.38	Professional	26	$8.91	$11.22	$17.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $33.11 / $51.29	Professional	TC	$24.55	$33.11	$51.29