Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $53.74 / $386.37 / $665.34	Facility		$53.74	$386.37	$665.34
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 $28.00 / $107.66 / $454.16	Facility	TC	$28.00	$107.66	$454.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $34.74 / $53.87 / $147.91	Professional		$34.74	$53.87	$147.91
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.52 / $15.01 / $61.28	Professional	26	$9.52	$15.01	$61.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.32 / $30.87 / $77.90	Professional	TC	$24.32	$30.87	$77.90
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $26.60 / $34.65 / $51.13	Professional		$26.60	$34.65	$51.13
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.95 / $9.96 / $14.58	Professional	26	$7.95	$9.96	$14.58
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $23.29 / $33.54 / $40.04	Professional	TC	$23.29	$33.54	$40.04
BCBS Facility/Professional Facility Modifier Low / Median / High Price $78.58 / $142.57 / $402.84	Facility		$78.58	$142.57	$402.84
BCBS Facility/Professional Professional Modifier Low / Median / High Price $13.51 / $46.03 / $80.90	Professional		$13.51	$46.03	$80.90
Cigna Facility/Professional Facility Modifier Low / Median / High Price $40.74 / $83.87 / $232.88	Facility		$40.74	$83.87	$232.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $31.93 / $52.31 / $77.50	Professional		$31.93	$52.31	$77.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.18 / $14.74 / $23.57	Professional	26	$9.18	$14.74	$23.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.08 / $37.31 / $56.75	Professional	TC	$23.08	$37.31	$56.75
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $45.67 / $67.50 / $146.65	Professional		$45.67	$67.50	$146.65
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.40 / $17.52 / $72.79	Professional	26	$12.40	$17.52	$72.79
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $28.07 / $41.83 / $95.16	Professional	TC	$28.07	$41.83	$95.16
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 Professional Modifier Low / Median / High Price $36.65 / $47.49 / $72.06	Professional		$36.65	$47.49	$72.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.97 / $13.72 / $22.34	Professional	26	$10.97	$13.72	$22.34
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.26 / $33.60 / $50.46	Professional	TC	$25.26	$33.60	$50.46