Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $46.94 / $311.16 / $534.60	Facility		$46.94	$311.16	$534.60
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.86 / $10.34 / $14.21	Facility	26	$6.86	$10.34	$14.21
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $22.63 / $37.01 / $396.16	Facility	TC	$22.63	$37.01	$396.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $14.30 / $36.65 / $114.95	Professional		$14.30	$36.65	$114.95
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.98 / $11.13 / $44.70	Professional	26	$6.98	$11.13	$44.70
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $94.79 / $103.26 / $141.60	Professional	50	$94.79	$103.26	$141.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.57 / $24.01 / $53.34	Professional	TC	$17.57	$24.01	$53.34
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $20.68 / $26.23 / $38.40	Professional		$20.68	$26.23	$38.40
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.65 / $7.32 / $10.98	Professional	26	$5.65	$7.32	$10.98
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $17.60 / $25.38 / $32.95	Professional	TC	$17.60	$25.38	$32.95
BCBS Facility/Professional Facility Modifier Low / Median / High Price $56.52 / $105.24 / $339.70	Facility		$56.52	$105.24	$339.70
BCBS Facility/Professional Professional Modifier Low / Median / High Price $9.82 / $36.77 / $70.48	Professional		$9.82	$36.77	$70.48
Cigna Facility/Professional Facility Modifier Low / Median / High Price $34.65 / $70.59 / $193.18	Facility		$34.65	$70.59	$193.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $24.82 / $41.04 / $59.83	Professional		$24.82	$41.04	$59.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.55 / $10.95 / $16.60	Professional	26	$6.55	$10.95	$16.60
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $38.29 / $38.29 / $43.42	Professional	50	$38.29	$38.29	$43.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.14 / $29.06 / $45.15	Professional	TC	$18.14	$29.06	$45.15
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $35.29 / $51.80 / $152.05	Professional		$35.29	$51.80	$152.05
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.42 / $13.35 / $59.58	Professional	26	$9.42	$13.35	$59.58
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $26.40 / $37.54 / $105.92	Professional	TC	$26.40	$37.54	$105.92
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 $37.40 / $38.00 / $41.60	Professional		$37.40	$38.00	$41.60
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.27 / $9.61 / $10.21	Professional	26	$9.27	$9.61	$10.21
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $27.81 / $28.72 / $31.40	Professional	TC	$27.81	$28.72	$31.40
Molina Facility/Professional Professional Modifier Low / Median / High Price $10.68 / $32.34 / $43.52	Professional		$10.68	$32.34	$43.52
United Facility/Professional Professional Modifier Low / Median / High Price $28.50 / $36.29 / $57.53	Professional		$28.50	$36.29	$57.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.28 / $10.27 / $16.38	Professional	26	$8.28	$10.27	$16.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.82 / $26.35 / $42.47	Professional	TC	$19.82	$26.35	$42.47