Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $45.71 / $234.42 / $602.56	Facility		$45.71	$234.42	$602.56
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.94 / $15.14 / $26.30	Facility	26	$7.94	$15.14	$26.30
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $25.70 / $45.71 / $131.83	Facility	TC	$25.70	$45.71	$131.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $43.65 / $147.91	Professional		$28.84	$43.65	$147.91
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $15.49 / $51.29	Professional	26	$7.94	$15.49	$51.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $28.18 / $54.95	Professional	TC	$20.42	$28.18	$54.95
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $23.44 / $24.55 / $27.54	Professional		$23.44	$24.55	$27.54
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $8.13 / $13.49	Professional	26	$6.46	$8.13	$13.49
BCBS Facility/Professional Facility Modifier Low / Median / High Price $74.13 / $138.04 / $331.13	Facility		$74.13	$138.04	$331.13
BCBS Facility/Professional Professional Modifier Low / Median / High Price $10.96 / $41.69 / $79.43	Professional		$10.96	$41.69	$79.43
Cigna Facility/Professional Facility Modifier Low / Median / High Price $26.30 / $60.26 / $134.90	Facility		$26.30	$60.26	$134.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $47.86 / $69.18	Professional		$30.20	$47.86	$69.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $13.49 / $21.88	Professional	26	$7.76	$13.49	$21.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $33.11 / $51.29	Professional	TC	$21.38	$33.11	$51.29
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $87.10 / $181.97	Professional		$42.66	$87.10	$181.97
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $19.05 / $75.86	Professional	26	$10.47	$19.05	$75.86
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $44.67 / $128.82	Professional	TC	$28.18	$44.67	$128.82
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 $42.66 / $43.65 / $46.77	Professional		$42.66	$43.65	$46.77
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $10.72 / $11.48	Professional	26	$10.47	$10.72	$11.48
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $32.36 / $35.48	Professional	TC	$31.62	$32.36	$35.48
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 $22.91 / $89.13 / $275.42	Facility		$22.91	$89.13	$275.42
United Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $42.66 / $64.57	Professional		$33.11	$42.66	$64.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $13.18 / $20.42	Professional	26	$10.00	$13.18	$20.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $30.20 / $44.67	Professional	TC	$22.91	$30.20	$44.67