Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $38.02 / $263.03 / $549.54	Facility		$38.02	$263.03	$549.54
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.59 / $11.22 / $25.70	Facility	26	$7.59	$11.22	$25.70
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $18.20 / $33.88 / $234.42	Facility	TC	$18.20	$33.88	$234.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $22.91 / $39.81 / $112.20	Professional		$22.91	$39.81	$112.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $11.48 / $36.31	Professional	26	$7.59	$11.48	$36.31
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $23.44 / $54.95	Professional	TC	$15.14	$23.44	$54.95
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $17.38 / $20.89 / $41.69	Professional		$17.38	$20.89	$41.69
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.31 / $7.76 / $11.75	Professional	26	$6.31	$7.76	$11.75
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $13.80 / $18.20 / $24.55	Professional	TC	$13.80	$18.20	$24.55
BCBS Facility/Professional Facility Modifier Low / Median / High Price $54.95 / $131.83 / $288.40	Facility		$54.95	$131.83	$288.40
BCBS Facility/Professional Professional Modifier Low / Median / High Price $10.72 / $32.36 / $57.54	Professional		$10.72	$32.36	$57.54
Cigna Facility/Professional Facility Modifier Low / Median / High Price $19.05 / $46.77 / $134.90	Facility		$19.05	$46.77	$134.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $23.44 / $38.02 / $54.95	Professional		$23.44	$38.02	$54.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $11.75 / $18.20	Professional	26	$7.41	$11.75	$18.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.60 / $26.30 / $40.74	Professional	TC	$16.60	$26.30	$40.74
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $63.10 / $190.55	Professional		$33.11	$63.10	$190.55
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $17.38 / $91.20	Professional	26	$10.00	$17.38	$91.20
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $33.11 / $120.23	Professional	TC	$19.95	$33.11	$120.23
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 $33.11 / $33.88 / $37.15	Professional		$33.11	$33.88	$37.15
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $10.47 / $10.96	Professional	26	$10.00	$10.47	$10.96
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $23.44 / $25.70	Professional	TC	$22.91	$23.44	$25.70
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 $18.20 / $89.13 / $275.42	Facility		$18.20	$89.13	$275.42
United Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $33.88 / $52.48	Professional		$25.70	$33.88	$52.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $10.47 / $16.22	Professional	26	$8.32	$10.47	$16.22
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $23.44 / $36.31	Professional	TC	$17.38	$23.44	$36.31