Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $89.96 / $343.89 / $739.11	Facility		$89.96	$343.89	$739.11
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.84 / $40.88 / $117.81	Facility	26	$29.84	$40.88	$117.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $58.62 / $97.63 / $382.00	Professional		$58.62	$97.63	$382.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.16 / $47.49 / $159.27	Professional	26	$29.16	$47.49	$159.27
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $106.52 / $227.37 / $727.50	Professional	50	$106.52	$227.37	$727.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.85 / $54.25 / $132.63	Professional	TC	$43.85	$54.25	$132.63
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $55.18 / $63.52 / $86.02	Professional		$55.18	$63.52	$86.02
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $23.81 / $30.99 / $46.01	Professional	26	$23.81	$30.99	$46.01
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $85.75 / $94.60 / $112.73	Professional	50	$85.75	$94.60	$112.73
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $44.55 / $44.55 / $49.67	Professional	TC	$44.55	$44.55	$49.67
BCBS Facility/Professional Facility Modifier Low / Median / High Price $119.38 / $256.81 / $769.58	Facility		$119.38	$256.81	$769.58
BCBS Facility/Professional Professional Modifier Low / Median / High Price $41.34 / $90.75 / $190.09	Professional		$41.34	$90.75	$190.09
Cigna Facility/Professional Facility Modifier Low / Median / High Price $85.73 / $142.86 / $251.63	Facility		$85.73	$142.86	$251.63
Cigna Facility/Professional Professional Modifier Low / Median / High Price $71.58 / $115.16 / $166.64	Professional		$71.58	$115.16	$166.64
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.05 / $44.59 / $65.48	Professional	26	$28.05	$44.59	$65.48
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $113.75 / $113.75 / $113.75	Professional	50	$113.75	$113.75	$113.75
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $44.07 / $70.56 / $101.16	Professional	TC	$44.07	$70.56	$101.16
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $93.84 / $136.50 / $425.50	Professional		$93.84	$136.50	$425.50
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.33 / $52.85 / $194.17	Professional	26	$36.33	$52.85	$194.17
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $51.12 / $75.29 / $257.92	Professional	TC	$51.12	$75.29	$257.92
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 $100.91 / $102.13 / $110.90	Professional		$100.91	$102.13	$110.90
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $39.21 / $40.51 / $42.94	Professional	26	$39.21	$40.51	$42.94
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $60.41 / $62.92 / $67.95	Professional	TC	$60.41	$62.92	$67.95
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $44.92 / $116.02	Professional		$32.34	$44.92	$116.02
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 $83.81 / $106.68 / $163.35	Professional		$83.81	$106.68	$163.35
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.92 / $41.77 / $67.38	Professional	26	$32.92	$41.77	$67.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $48.59 / $65.39 / $95.93	Professional	TC	$48.59	$65.39	$95.93