Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $53.36 / $348.66 / $617.70	Facility		$53.36	$348.66	$617.70
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.50 / $14.25 / $18.92	Facility	26	$9.50	$14.25	$18.92
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $27.69 / $46.58 / $403.20	Facility	TC	$27.69	$46.58	$403.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $34.43 / $52.25 / $108.83	Professional		$34.43	$52.25	$108.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.60 / $14.58 / $52.80	Professional	26	$9.60	$14.58	$52.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.04 / $28.92 / $56.76	Professional	TC	$24.04	$28.92	$56.76
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $28.20 / $34.65 / $48.52	Professional		$28.20	$34.65	$48.52
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.72 / $9.96 / $14.58	Professional	26	$7.72	$9.96	$14.58
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $24.69 / $33.54 / $39.29	Professional	TC	$24.69	$33.54	$39.29
BCBS Facility/Professional Facility Modifier Low / Median / High Price $70.80 / $125.93 / $398.32	Facility		$70.80	$125.93	$398.32
BCBS Facility/Professional Professional Modifier Low / Median / High Price $13.51 / $46.03 / $80.98	Professional		$13.51	$46.03	$80.98
Cigna Facility/Professional Facility Modifier Low / Median / High Price $37.71 / $83.87 / $232.88	Facility		$37.71	$83.87	$232.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $31.67 / $50.63 / $75.13	Professional		$31.67	$50.63	$75.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.18 / $14.70 / $23.57	Professional	26	$9.18	$14.70	$23.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.82 / $36.20 / $54.44	Professional	TC	$22.82	$36.20	$54.44
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $44.34 / $64.84 / $123.57	Professional		$44.34	$64.84	$123.57
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.01 / $18.39 / $68.83	Professional	26	$13.01	$18.39	$68.83
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $29.26 / $43.67 / $97.40	Professional	TC	$29.26	$43.67	$97.40
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 $46.84 / $47.76 / $51.88	Professional		$46.84	$47.76	$51.88
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.01 / $13.29 / $14.04	Professional	26	$13.01	$13.29	$14.04
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $33.57 / $34.75 / $37.84	Professional	TC	$33.57	$34.75	$37.84
Molina Facility/Professional Professional Modifier Low / Median / High Price $14.69 / $32.34 / $54.28	Professional		$14.69	$32.34	$54.28
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 $35.79 / $46.58 / $71.28	Professional		$35.79	$46.58	$71.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.97 / $14.12 / $21.62	Professional	26	$10.97	$14.12	$21.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.17 / $33.22 / $50.92	Professional	TC	$24.17	$33.22	$50.92