Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $36.97 / $261.39 / $522.88	Facility		$36.97	$261.39	$522.88
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.79 / $10.33 / $13.11	Facility	26	$6.79	$10.33	$13.11
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $19.18 / $29.94 / $232.20	Facility	TC	$19.18	$29.94	$232.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $23.46 / $34.89 / $92.54	Professional		$23.46	$34.89	$92.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.62 / $10.02 / $52.11	Professional	26	$6.62	$10.02	$52.11
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $54.54 / $94.79 / $276.00	Professional	50	$54.54	$94.79	$276.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $10.88 / $13.71 / $24.37	Professional	52	$10.88	$13.71	$24.37
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.44 / $20.43 / $39.29	Professional	TC	$17.44	$20.43	$39.29
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $15.35 / $20.66 / $28.53	Professional		$15.35	$20.66	$28.53
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.11 / $7.89 / $10.55	Professional	26	$5.11	$7.89	$10.55
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $35.17 / $35.17 / $35.17	Professional	50	$35.17	$35.17	$35.17
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $28.83 / $28.83 / $28.83	Professional	TC	$28.83	$28.83	$28.83
BCBS Facility/Professional Facility Modifier Low / Median / High Price $54.95 / $101.06 / $297.73	Facility		$54.95	$101.06	$297.73
BCBS Facility/Professional Professional Modifier Low / Median / High Price $9.41 / $33.00 / $58.88	Professional		$9.41	$33.00	$58.88
Cigna Facility/Professional Facility Modifier Low / Median / High Price $31.62 / $62.86 / $169.35	Facility		$31.62	$62.86	$169.35
Cigna Facility/Professional Professional Modifier Low / Median / High Price $23.03 / $37.29 / $53.65	Professional		$23.03	$37.29	$53.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.24 / $10.15 / $15.69	Professional	26	$6.24	$10.15	$15.69
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $35.13 / $35.13 / $39.76	Professional	50	$35.13	$35.13	$39.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.79 / $27.31 / $39.59	Professional	TC	$16.79	$27.31	$39.59
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $32.93 / $46.29 / $90.20	Professional		$32.93	$46.29	$90.20
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.02 / $12.78 / $53.42	Professional	26	$9.02	$12.78	$53.42
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $19.68 / $30.36 / $63.57	Professional	TC	$19.68	$30.36	$63.57
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 $33.58 / $33.97 / $37.29	Professional		$33.58	$33.97	$37.29
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $8.88 / $9.23 / $9.77	Professional	26	$8.88	$9.23	$9.77
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $24.36 / $25.09 / $27.52	Professional	TC	$24.36	$25.09	$27.52
Molina Facility/Professional Professional Modifier Low / Median / High Price $10.23 / $32.34 / $39.02	Professional		$10.23	$32.34	$39.02
United Facility/Professional Professional Modifier Low / Median / High Price $26.47 / $34.40 / $54.96	Professional		$26.47	$34.40	$54.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.75 / $9.65 / $15.03	Professional	26	$7.75	$9.65	$15.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.54 / $24.51 / $37.51	Professional	TC	$18.54	$24.51	$37.51