Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $89.13 / $323.59 / $660.69	Facility		$89.13	$323.59	$660.69
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.84 / $41.69 / $100.00	Facility	26	$28.84	$41.69	$100.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $100.00 / $371.54	Professional		$50.12	$100.00	$371.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $61.66 / $173.78	Professional	26	$30.20	$61.66	$173.78
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $66.07 / $181.97 / $660.69	Professional	50	$66.07	$181.97	$660.69
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $60.26 / $147.91	Professional	TC	$43.65	$60.26	$147.91
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $67.61 / $117.49	Professional		$61.66	$67.61	$117.49
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $33.88 / $56.23	Professional	26	$23.99	$33.88	$56.23
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $91.20 / $100.00 / $173.78	Professional	50	$91.20	$100.00	$173.78
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $48.98 / $66.07	Professional	TC	$33.88	$48.98	$66.07
BCBS Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $234.42 / $741.31	Facility		$112.20	$234.42	$741.31
BCBS Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $85.11 / $181.97	Professional		$41.69	$85.11	$181.97
Cigna Facility/Professional Facility Modifier Low / Median / High Price $51.29 / $117.49 / $251.19	Facility		$51.29	$117.49	$251.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $114.82 / $169.82	Professional		$69.18	$114.82	$169.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $45.71 / $69.18	Professional	26	$27.54	$45.71	$69.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $70.79 / $109.65	Professional	TC	$43.65	$70.79	$109.65
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $173.78 / $467.74	Professional		$95.50	$173.78	$467.74
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $66.07 / $194.98	Professional	26	$36.31	$66.07	$194.98
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $77.62 / $275.42	Professional	TC	$44.67	$77.62	$275.42
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 Professional Modifier Low / Median / High Price $100.00 / $102.33 / $109.65	Professional		$100.00	$102.33	$109.65
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $40.74 / $42.66	Professional	26	$38.90	$40.74	$42.66
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $63.10 / $67.61	Professional	TC	$60.26	$63.10	$67.61
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $33.11	Professional		$32.36	$33.11	$33.11
United Facility/Professional Facility Modifier Low / Median / High Price $57.54 / $74.13 / $229.09	Facility		$57.54	$74.13	$229.09
United Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $102.33 / $151.36	Professional		$79.43	$102.33	$151.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $40.74 / $61.66	Professional	26	$30.90	$40.74	$61.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $63.10 / $93.33	Professional	TC	$47.86	$63.10	$93.33