Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $60.84 / $324.39 / $640.94	Facility		$60.84	$324.39	$640.94
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.44 / $11.16 / $14.81	Facility	26	$7.44	$11.16	$14.81
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $27.37 / $177.74 / $474.16	Facility	TC	$27.37	$177.74	$474.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $13.86 / $43.23 / $118.71	Professional		$13.86	$43.23	$118.71
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.44 / $13.10 / $52.29	Professional	26	$7.44	$13.10	$52.29
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $30.77 / $106.26 / $130.82	Professional	50	$30.77	$106.26	$130.82
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $13.64 / $17.60 / $25.45	Professional	52	$13.64	$17.60	$25.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.94 / $30.03 / $75.05	Professional	TC	$21.94	$30.03	$75.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $23.67 / $35.33 / $46.75	Professional		$23.67	$35.33	$46.75
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.12 / $7.94 / $11.49	Professional	26	$6.12	$7.94	$11.49
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $45.05 / $45.05 / $45.05	Professional	50	$45.05	$45.05	$45.05
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $23.84 / $33.63 / $37.96	Professional	TC	$23.84	$33.63	$37.96
BCBS Facility/Professional Facility Modifier Low / Median / High Price $60.61 / $114.20 / $405.00	Facility		$60.61	$114.20	$405.00
BCBS Facility/Professional Professional Modifier Low / Median / High Price $10.65 / $42.08 / $75.08	Professional		$10.65	$42.08	$75.08
Cigna Facility/Professional Facility Modifier Low / Median / High Price $38.31 / $81.66 / $224.94	Facility		$38.31	$81.66	$224.94
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.60 / $44.03 / $66.79	Professional		$28.60	$44.03	$66.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $11.48 / $17.80	Professional	26	$7.08	$11.48	$17.80
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $43.28 / $43.28 / $49.18	Professional	50	$43.28	$43.28	$49.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.79 / $33.74 / $52.58	Professional	TC	$20.79	$33.74	$52.58
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $40.28 / $58.59 / $167.03	Professional		$40.28	$58.59	$167.03
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.64 / $13.62 / $59.46	Professional	26	$9.64	$13.62	$59.46
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $27.77 / $42.04 / $92.46	Professional	TC	$27.77	$42.04	$92.46
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 $42.82 / $43.64 / $47.61	Professional		$42.82	$43.64	$47.61
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.10 / $10.41 / $11.06	Professional	26	$10.10	$10.41	$11.06
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $32.40 / $33.54 / $36.56	Professional	TC	$32.40	$33.54	$36.56
Molina Facility/Professional Professional Modifier Low / Median / High Price $11.57 / $32.34 / $49.80	Professional		$11.57	$32.34	$49.80
United Facility/Professional Facility Modifier Low / Median / High Price $9.34 / $29.50 / $104.26	Facility		$9.34	$29.50	$104.26
United Facility/Professional Professional Modifier Low / Median / High Price $31.69 / $42.38 / $66.59	Professional		$31.69	$42.38	$66.59
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.58 / $10.90 / $17.02	Professional	26	$8.58	$10.90	$17.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.82 / $30.91 / $48.72	Professional	TC	$22.82	$30.91	$48.72