Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $40.82 / $117.12 / $331.20	Facility		$40.82	$117.12	$331.20
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.75 / $48.24 / $54.25	Facility	26	$25.75	$48.24	$54.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $36.10 / $79.53 / $171.12	Professional		$36.10	$79.53	$171.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.75 / $34.32 / $82.24	Professional	26	$25.75	$34.32	$82.24
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $42.41 / $209.10 / $330.55	Professional	50	$42.41	$209.10	$330.55
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $18.05 / $24.08 / $52.65	Professional	52	$18.05	$24.08	$52.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $14.85 / $36.15 / $92.53	Professional	TC	$14.85	$36.15	$92.53
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $40.35 / $59.04 / $59.04	Professional		$40.35	$59.04	$59.04
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.62 / $25.62 / $25.62	Professional	26	$25.62	$25.62	$25.62
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $14.72 / $14.72 / $14.72	Professional	TC	$14.72	$14.72	$14.72
BCBS Facility/Professional Facility Modifier Low / Median / High Price $155.91 / $225.61 / $484.22	Facility		$155.91	$225.61	$484.22
BCBS Facility/Professional Professional Modifier Low / Median / High Price $32.71 / $58.69 / $111.25	Professional		$32.71	$58.69	$111.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $47.25 / $75.70 / $146.34	Professional		$47.25	$75.70	$146.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.38 / $39.82 / $57.51	Professional	26	$27.38	$39.82	$57.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.04 / $31.20 / $92.68	Professional	TC	$17.04	$31.20	$92.68
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $51.72 / $75.15 / $190.06	Professional		$51.72	$75.15	$190.06
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.44 / $45.12 / $142.11	Professional	26	$32.44	$45.12	$142.11
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $18.41 / $26.30 / $112.87	Professional	TC	$18.41	$26.30	$112.87
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 $56.47 / $57.19 / $61.13	Professional		$56.47	$57.19	$61.13
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.32 / $36.53 / $38.34	Professional	26	$36.32	$36.53	$38.34
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $20.14 / $20.66 / $22.79	Professional	TC	$20.14	$20.66	$22.79
Molina Facility/Professional Professional Modifier Low / Median / High Price $23.84 / $32.34 / $63.95	Professional		$23.84	$32.34	$63.95
United Facility/Professional Professional Modifier Low / Median / High Price $60.34 / $92.44 / $143.47	Professional		$60.34	$92.44	$143.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.73 / $37.33 / $64.73	Professional	26	$27.73	$37.33	$64.73
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.58 / $49.97 / $78.75	Professional	TC	$28.58	$49.97	$78.75