Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $45.63 / $286.13 / $486.00	Facility		$45.63	$286.13	$486.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.36 / $12.06 / $14.21	Facility	26	$7.36	$12.06	$14.21
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $23.58 / $33.32 / $83.15	Facility	TC	$23.58	$33.32	$83.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $19.73 / $33.18 / $96.72	Professional		$19.73	$33.18	$96.72
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.03 / $9.53 / $31.74	Professional	26	$7.03	$9.53	$31.74
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $21.98 / $48.70 / $105.91	Professional	50	$21.98	$48.70	$105.91
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $12.18 / $15.66 / $27.96	Professional	52	$12.18	$15.66	$27.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.53 / $23.59 / $56.85	Professional	TC	$18.53	$23.59	$56.85
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $19.10 / $23.87 / $58.77	Professional		$19.10	$23.87	$58.77
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.58 / $7.66 / $10.98	Professional	26	$5.58	$7.66	$10.98
BCBS Facility/Professional Facility Modifier Low / Median / High Price $56.52 / $105.24 / $349.01	Facility		$56.52	$105.24	$349.01
BCBS Facility/Professional Professional Modifier Low / Median / High Price $9.82 / $37.15 / $71.20	Professional		$9.82	$37.15	$71.20
Cigna Facility/Professional Facility Modifier Low / Median / High Price $37.01 / $72.81 / $195.82	Facility		$37.01	$72.81	$195.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $25.56 / $40.20 / $60.45	Professional		$25.56	$40.20	$60.45
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.79 / $10.68 / $16.55	Professional	26	$6.79	$10.68	$16.55
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $40.11 / $40.11 / $45.51	Professional	50	$40.11	$40.11	$45.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.39 / $29.28 / $45.77	Professional	TC	$18.39	$29.28	$45.77
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $35.56 / $52.04 / $120.00	Professional		$35.56	$52.04	$120.00
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.42 / $13.30 / $53.42	Professional	26	$9.42	$13.30	$53.42
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $23.86 / $35.25 / $73.12	Professional	TC	$23.86	$35.25	$73.12
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 $37.79 / $38.39 / $42.03	Professional		$37.79	$38.39	$42.03
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 $28.20 / $29.12 / $31.82	Professional	TC	$28.20	$29.12	$31.82
Molina Facility/Professional Professional Modifier Low / Median / High Price $10.68 / $32.34 / $43.97	Professional		$10.68	$32.34	$43.97
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 $27.30 / $37.88 / $60.57	Professional		$27.30	$37.88	$60.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.08 / $10.42 / $16.92	Professional	26	$8.08	$10.42	$16.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.12 / $26.81 / $42.23	Professional	TC	$20.12	$26.81	$42.23