Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $43.65 / $218.78 / $478.63	Facility		$43.65	$218.78	$478.63
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.12 / $17.38 / $239.88	Facility	26	$9.12	$17.38	$239.88
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $22.39 / $91.20 / $407.38	Facility	TC	$22.39	$91.20	$407.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $48.98 / $162.18	Professional		$28.18	$48.98	$162.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $14.45 / $48.98	Professional	26	$9.33	$14.45	$48.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $29.51 / $64.57	Professional	TC	$19.05	$29.51	$64.57
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $20.89 / $25.70 / $42.66	Professional		$20.89	$25.70	$42.66
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $9.77 / $14.79	Professional	26	$7.76	$9.77	$14.79
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $14.79 / $19.50 / $31.62	Professional	TC	$14.79	$19.50	$31.62
BCBS Facility/Professional Facility Modifier Low / Median / High Price $72.44 / $100.00 / $245.47	Facility		$72.44	$100.00	$245.47
BCBS Facility/Professional Professional Modifier Low / Median / High Price $13.18 / $38.90 / $75.86	Professional		$13.18	$38.90	$75.86
Cigna Facility/Professional Facility Modifier Low / Median / High Price $22.39 / $63.10 / $131.83	Facility		$22.39	$63.10	$131.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $40.74 / $61.66	Professional		$26.92	$40.74	$61.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.71 / $14.13 / $21.38	Professional	26	$8.71	$14.13	$21.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $27.54 / $42.66	Professional	TC	$18.20	$27.54	$42.66
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $67.61 / $223.87	Professional		$39.81	$67.61	$223.87
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $15.85 / $69.18	Professional	26	$11.48	$15.85	$69.18
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $39.81 / $165.96	Professional	TC	$23.44	$39.81	$165.96
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 $39.81 / $40.74 / $43.65	Professional		$39.81	$40.74	$43.65
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $12.59 / $13.49	Professional	26	$11.48	$12.59	$13.49
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $28.18 / $30.20	Professional	TC	$26.92	$28.18	$30.20
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 $19.95 / $74.13 / $229.09	Facility		$19.95	$74.13	$229.09
United Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $38.02 / $56.23	Professional		$29.51	$38.02	$56.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $12.88 / $19.95	Professional	26	$10.47	$12.88	$19.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $25.12 / $38.02	Professional	TC	$18.62	$25.12	$38.02