Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $39.81 / $117.49 / $323.59	Facility		$39.81	$117.49	$323.59
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.12 / $45.71 / $47.86	Facility	26	$25.12	$45.71	$47.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $79.43 / $204.17	Professional		$39.81	$79.43	$204.17
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $38.90 / $91.20	Professional	26	$26.92	$38.90	$91.20
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $42.66 / $107.15 / $331.13	Professional	50	$42.66	$107.15	$331.13
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $15.85 / $37.15 / $43.65	Professional	52	$15.85	$37.15	$43.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $34.67 / $128.82	Professional	TC	$15.14	$34.67	$128.82
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $43.65 / $67.61	Professional		$40.74	$43.65	$67.61
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $28.18 / $42.66	Professional	26	$25.70	$28.18	$42.66
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $69.18 / $69.18 / $100.00	Professional	50	$69.18	$69.18	$100.00
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $13.80 / $16.60 / $27.54	Professional	TC	$13.80	$16.60	$27.54
BCBS Facility/Professional Facility Modifier Low / Median / High Price $162.18 / $208.93 / $501.19	Facility		$162.18	$208.93	$501.19
BCBS Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $58.88 / $112.20	Professional		$32.36	$58.88	$112.20
Cigna Facility/Professional Facility Modifier Low / Median / High Price $70.79 / $97.72 / $125.89	Facility		$70.79	$97.72	$125.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $81.28 / $151.36	Professional		$45.71	$81.28	$151.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $39.81 / $63.10	Professional	26	$27.54	$39.81	$63.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $38.02 / $93.33	Professional	TC	$16.98	$38.02	$93.33
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $100.00 / $263.03	Professional		$52.48	$100.00	$263.03
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $50.12 / $165.96	Professional	26	$32.36	$50.12	$165.96
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $26.30 / $181.97	Professional	TC	$17.78	$26.30	$181.97
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 $56.23 / $57.54 / $61.66	Professional		$56.23	$57.54	$61.66
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $36.31 / $38.02	Professional	26	$36.31	$36.31	$38.02
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $20.89 / $22.91	Professional	TC	$19.95	$20.89	$22.91
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 $30.20 / $97.72 / $467.74	Facility		$30.20	$97.72	$467.74
United Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $85.11 / $134.90	Professional		$56.23	$85.11	$134.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $34.67 / $54.95	Professional	26	$26.92	$34.67	$54.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $47.86 / $79.43	Professional	TC	$26.92	$47.86	$79.43