Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $32.49 / $150.59 / $290.23	Facility		$32.49	$150.59	$290.23
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.50 / $33.76 / $38.65	Facility	26	$16.50	$33.76	$38.65
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $14.49 / $229.17 / $369.46	Facility	TC	$14.49	$229.17	$369.46
Aetna Facility/Professional Professional Modifier Low / Median / High Price $32.49 / $70.14 / $124.37	Professional		$32.49	$70.14	$124.37
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $71.59 / $71.59 / $71.59	Professional	25	$71.59	$71.59	$71.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.36 / $24.48 / $49.39	Professional	26	$17.36	$24.48	$49.39
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $50.31 / $234.74 / $281.35	Professional	50	$50.31	$234.74	$281.35
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $14.30 / $19.82 / $40.33	Professional	52	$14.30	$19.82	$40.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $12.96 / $30.45 / $80.70	Professional	TC	$12.96	$30.45	$80.70
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $34.26 / $35.78 / $45.95	Professional		$34.26	$35.78	$45.95
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $23.15 / $23.15 / $23.15	Professional	26	$23.15	$23.15	$23.15
BCBS Facility/Professional Facility Modifier Low / Median / High Price $142.87 / $202.31 / $423.45	Facility		$142.87	$202.31	$423.45
BCBS Facility/Professional Professional Modifier Low / Median / High Price $22.51 / $37.59 / $55.86	Professional		$22.51	$37.59	$55.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $36.60 / $64.53 / $127.05	Professional		$36.60	$64.53	$127.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.36 / $28.42 / $45.04	Professional	26	$19.36	$28.42	$45.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.86 / $29.77 / $79.80	Professional	TC	$15.86	$29.77	$79.80
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $42.22 / $61.89 / $133.87	Professional		$42.22	$61.89	$133.87
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $23.83 / $32.47 / $100.34	Professional	26	$23.83	$32.47	$100.34
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $17.37 / $25.99 / $78.62	Professional	TC	$17.37	$25.99	$78.62
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 Facility Modifier TC Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	TC	$100.00	$100.00	$100.00
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $44.06 / $44.46 / $47.89	Professional		$44.06	$44.46	$47.89
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.01 / $25.08 / $26.39	Professional	26	$25.01	$25.08	$26.39
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $18.98 / $19.46 / $21.50	Professional	TC	$18.98	$19.46	$21.50
Molina Facility/Professional Professional Modifier Low / Median / High Price $20.45 / $32.34 / $50.10	Professional		$20.45	$32.34	$50.10
United Facility/Professional Professional Modifier Low / Median / High Price $45.42 / $73.15 / $120.20	Professional		$45.42	$73.15	$120.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.80 / $27.59 / $47.45	Professional	26	$19.80	$27.59	$47.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.30 / $39.84 / $70.14	Professional	TC	$21.30	$39.84	$70.14