Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $43.77 / $249.97 / $454.66	Facility		$43.77	$249.97	$454.66
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.51 / $13.88 / $195.25	Facility	26	$9.51	$13.88	$195.25
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $23.24 / $185.37 / $403.20	Facility	TC	$23.24	$185.37	$403.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $27.58 / $40.63 / $144.00	Professional		$27.58	$40.63	$144.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.66 / $15.71 / $58.00	Professional	26	$9.66	$15.71	$58.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.92 / $22.81 / $51.84	Professional	TC	$17.92	$22.81	$51.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $23.83 / $31.95 / $44.29	Professional		$23.83	$31.95	$44.29
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.66 / $10.24 / $14.13	Professional	26	$7.66	$10.24	$14.13
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $18.79 / $26.96 / $31.71	Professional	TC	$18.79	$26.96	$31.71
BCBS Facility/Professional Facility Modifier Low / Median / High Price $75.23 / $75.23 / $191.89	Facility		$75.23	$75.23	$191.89
BCBS Facility/Professional Professional Modifier Low / Median / High Price $13.10 / $39.25 / $75.23	Professional		$13.10	$39.25	$75.23
Cigna Facility/Professional Facility Modifier Low / Median / High Price $45.20 / $71.08 / $217.52	Facility		$45.20	$71.08	$217.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.94 / $43.12 / $63.49	Professional		$26.94	$43.12	$63.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.80 / $14.13 / $22.07	Professional	26	$8.80	$14.13	$22.07
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.82 / $28.98 / $43.92	Professional	TC	$17.82	$28.98	$43.92
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $39.17 / $58.52 / $202.10	Professional		$39.17	$58.52	$202.10
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.52 / $15.87 / $55.30	Professional	26	$11.52	$15.87	$55.30
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $22.88 / $36.40 / $129.35	Professional	TC	$22.88	$36.40	$129.35
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 $39.94 / $40.52 / $44.14	Professional		$39.94	$40.52	$44.14
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.57 / $12.61 / $13.61	Professional	26	$11.57	$12.61	$13.61
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $27.04 / $27.91 / $30.54	Professional	TC	$27.04	$27.91	$30.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $14.24 / $32.34 / $46.17	Professional		$14.24	$32.34	$46.17
United Facility/Professional Professional Modifier Low / Median / High Price $30.58 / $39.84 / $59.76	Professional		$30.58	$39.84	$59.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.02 / $16.22 / $50.41	Professional	26	$11.02	$16.22	$50.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.26 / $30.88 / $77.95	Professional	TC	$20.26	$30.88	$77.95