Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $45.71 / $288.40 / $524.81	Facility		$45.71	$288.40	$524.81
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.92 / $9.55 / $21.38	Facility	26	$6.92	$9.55	$21.38
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $21.88 / $40.74 / $398.11	Facility	TC	$21.88	$40.74	$398.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $10.00 / $34.67 / $114.82	Professional		$10.00	$34.67	$114.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $13.80 / $44.67	Professional	26	$7.08	$13.80	$44.67
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $22.39 / $95.50 / $257.04	Professional	50	$22.39	$95.50	$257.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $30.20 / $69.18	Professional	TC	$18.20	$30.20	$69.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $19.50 / $23.99 / $39.81	Professional		$19.50	$23.99	$39.81
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.75 / $7.41 / $11.75	Professional	26	$5.75	$7.41	$11.75
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $56.23 / $56.23 / $56.23	Professional	50	$56.23	$56.23	$56.23
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $15.49 / $22.91 / $31.62	Professional	TC	$15.49	$22.91	$31.62
BCBS Facility/Professional Facility Modifier Low / Median / High Price $56.23 / $112.20 / $288.40	Facility		$56.23	$112.20	$288.40
BCBS Facility/Professional Professional Modifier Low / Median / High Price $9.77 / $37.15 / $70.79	Professional		$9.77	$37.15	$70.79
Cigna Facility/Professional Facility Modifier Low / Median / High Price $23.44 / $47.86 / $120.23	Facility		$23.44	$47.86	$120.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $38.02 / $57.54	Professional		$24.55	$38.02	$57.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.76 / $10.96 / $16.60	Professional	26	$6.76	$10.96	$16.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $28.18 / $43.65	Professional	TC	$18.20	$28.18	$43.65
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $72.44 / $173.78	Professional		$35.48	$72.44	$173.78
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $16.22 / $60.26	Professional	26	$9.33	$16.22	$60.26
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $42.66 / $107.15	Professional	TC	$25.12	$42.66	$107.15
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 $37.15 / $38.02 / $41.69	Professional		$37.15	$38.02	$41.69
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $9.55 / $10.23	Professional	26	$9.33	$9.55	$10.23
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $28.84 / $31.62	Professional	TC	$27.54	$28.84	$31.62
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 $17.78 / $74.13 / $229.09	Facility		$17.78	$74.13	$229.09
United Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $35.48 / $53.70	Professional		$26.92	$35.48	$53.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $9.77 / $14.79	Professional	26	$7.94	$9.77	$14.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $25.70 / $38.90	Professional	TC	$19.05	$25.70	$38.90