Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $48.62 / $297.31 / $557.50	Facility		$48.62	$297.31	$557.50
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.38 / $10.80 / $21.72	Facility	26	$7.38	$10.80	$21.72
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $25.17 / $177.31 / $524.34	Facility	TC	$25.17	$177.31	$524.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $14.17 / $44.01 / $122.54	Professional		$14.17	$44.01	$122.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.33 / $12.09 / $53.49	Professional	26	$7.33	$12.09	$53.49
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $16.22 / $82.23 / $159.50	Professional	50	$16.22	$82.23	$159.50
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $12.77 / $16.44 / $23.85	Professional	52	$12.77	$16.44	$23.85
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.32 / $29.33 / $78.84	Professional	TC	$21.32	$29.33	$78.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $23.93 / $30.57 / $43.77	Professional		$23.93	$30.57	$43.77
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.90 / $7.65 / $11.34	Professional	26	$5.90	$7.65	$11.34
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $37.77 / $48.35 / $48.35	Professional	50	$37.77	$48.35	$48.35
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $22.14 / $30.06 / $35.28	Professional	TC	$22.14	$30.06	$35.28
BCBS Facility/Professional Facility Modifier Low / Median / High Price $51.62 / $51.62 / $182.43	Facility		$51.62	$51.62	$182.43
BCBS Facility/Professional Professional Modifier Low / Median / High Price $10.23 / $39.44 / $70.37	Professional		$10.23	$39.44	$70.37
Cigna Facility/Professional Facility Modifier Low / Median / High Price $35.27 / $76.14 / $209.06	Facility		$35.27	$76.14	$209.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $27.20 / $42.70 / $64.16	Professional		$27.20	$42.70	$64.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.81 / $11.06 / $17.07	Professional	26	$6.81	$11.06	$17.07
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $40.56 / $40.56 / $46.03	Professional	50	$40.56	$40.56	$46.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.37 / $31.36 / $48.87	Professional	TC	$20.37	$31.36	$48.87
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $37.74 / $55.58 / $130.47	Professional		$37.74	$55.58	$130.47
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.27 / $13.12 / $58.56	Professional	26	$9.27	$13.12	$58.56
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.48 / $37.63 / $78.42	Professional	TC	$25.48	$37.63	$78.42
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 $40.14 / $40.83 / $44.60	Professional		$40.14	$40.83	$44.60
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.69 / $10.03 / $10.63	Professional	26	$9.69	$10.03	$10.63
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $30.11 / $31.12 / $33.97	Professional	TC	$30.11	$31.12	$33.97
Molina Facility/Professional Professional Modifier Low / Median / High Price $11.12 / $32.34 / $46.66	Professional		$11.12	$32.34	$46.66
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 $29.99 / $39.43 / $62.26	Professional		$29.99	$39.43	$62.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.44 / $10.50 / $17.00	Professional	26	$8.44	$10.50	$17.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.09 / $28.89 / $46.21	Professional	TC	$22.09	$28.89	$46.21