Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $34.85 / $276.93 / $526.00	Facility		$34.85	$276.93	$526.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.74 / $10.95 / $15.41	Facility	26	$7.74	$10.95	$15.41
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $16.66 / $95.23 / $364.71	Facility	TC	$16.66	$95.23	$364.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $17.78 / $25.00 / $55.23	Professional		$17.78	$25.00	$55.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.02 / $10.19 / $41.80	Professional	26	$8.02	$10.19	$41.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $9.69 / $15.81 / $28.14	Professional	TC	$9.69	$15.81	$28.14
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $19.32 / $24.67 / $25.45	Professional		$19.32	$24.67	$25.45
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.36 / $7.43 / $12.11	Professional	26	$6.36	$7.43	$12.11
BCBS Facility/Professional Facility Modifier Low / Median / High Price $49.60 / $97.60 / $217.25	Facility		$49.60	$97.60	$217.25
BCBS Facility/Professional Professional Modifier Low / Median / High Price $11.05 / $30.44 / $58.34	Professional		$11.05	$30.44	$58.34
Cigna Facility/Professional Facility Modifier Low / Median / High Price $34.24 / $52.62 / $162.35	Facility		$34.24	$52.62	$162.35
Cigna Facility/Professional Professional Modifier Low / Median / High Price $19.55 / $31.13 / $47.65	Professional		$19.55	$31.13	$47.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.37 / $11.92 / $18.50	Professional	26	$7.37	$11.92	$18.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $11.13 / $19.76 / $31.20	Professional	TC	$11.13	$19.76	$31.20
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $30.38 / $44.02 / $120.00	Professional		$30.38	$44.02	$120.00
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.41 / $15.01 / $58.31	Professional	26	$10.41	$15.01	$58.31
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $19.01 / $25.10 / $55.11	Professional	TC	$19.01	$25.10	$55.11
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 $30.98 / $31.19 / $34.27	Professional		$30.98	$31.19	$34.27
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.53 / $10.83 / $11.48	Professional	26	$10.53	$10.83	$11.48
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $19.37 / $20.14 / $22.79	Professional	TC	$19.37	$20.14	$22.79
Molina Facility/Professional Professional Modifier Low / Median / High Price $12.01 / $32.34 / $35.85	Professional		$12.01	$32.34	$35.85
United Facility/Professional Facility Modifier Low / Median / High Price $99.68 / $99.68 / $104.26	Facility		$99.68	$99.68	$104.26
United Facility/Professional Professional Modifier Low / Median / High Price $21.63 / $33.77 / $79.79	Professional		$21.63	$33.77	$79.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.11 / $11.83 / $17.66	Professional	26	$9.11	$11.83	$17.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $10.82 / $17.55 / $30.92	Professional	TC	$10.82	$17.55	$30.92