Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $45.20 / $154.00 / $400.13	Facility		$45.20	$154.00	$400.13
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.22 / $69.76 / $89.43	Facility	26	$28.22	$69.76	$89.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $42.30 / $82.79 / $172.31	Professional		$42.30	$82.79	$172.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.47 / $47.09 / $97.40	Professional	26	$26.47	$47.09	$97.40
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $82.23 / $104.00 / $179.00	Professional	50	$82.23	$104.00	$179.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $14.69 / $32.97 / $64.75	Professional	TC	$14.69	$32.97	$64.75
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $29.56 / $29.56 / $29.56	Professional		$29.56	$29.56	$29.56
BCBS Facility/Professional Facility Modifier Low / Median / High Price $138.56 / $218.79 / $476.54	Facility		$138.56	$218.79	$476.54
BCBS Facility/Professional Professional Modifier Low / Median / High Price $37.31 / $59.66 / $107.95	Professional		$37.31	$59.66	$107.95
Cigna Facility/Professional Facility Modifier Low / Median / High Price $40.06 / $67.29 / $168.48	Facility		$40.06	$67.29	$168.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $45.94 / $76.11 / $163.12	Professional		$45.94	$76.11	$163.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.98 / $44.72 / $84.69	Professional	26	$27.98	$44.72	$84.69
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $79.23 / $79.23 / $79.23	Professional	50	$79.23	$79.23	$79.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.89 / $28.51 / $95.27	Professional	TC	$16.89	$28.51	$95.27
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $52.68 / $81.04 / $301.64	Professional		$52.68	$81.04	$301.64
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.94 / $49.53 / $267.20	Professional	26	$32.94	$49.53	$267.20
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $17.45 / $28.06 / $168.41	Professional	TC	$17.45	$28.06	$168.41
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 Professional Modifier Low / Median / High Price $57.30 / $58.03 / $61.97	Professional		$57.30	$58.03	$61.97
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.79 / $36.97 / $38.75	Professional	26	$36.79	$36.97	$38.75
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $20.53 / $21.06 / $23.22	Professional	TC	$20.53	$21.06	$23.22
Molina Facility/Professional Professional Modifier Low / Median / High Price $24.29 / $32.34 / $64.83	Professional		$24.29	$32.34	$64.83
United Facility/Professional Facility Modifier Low / Median / High Price $128.26 / $128.26 / $180.02	Facility		$128.26	$128.26	$180.02
United Facility/Professional Professional Modifier Low / Median / High Price $53.09 / $91.41 / $140.11	Professional		$53.09	$91.41	$140.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.84 / $48.33 / $76.86	Professional	26	$31.84	$48.33	$76.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.55 / $35.82 / $62.56	Professional	TC	$20.55	$35.82	$62.56