Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $44.48 / $306.16 / $504.68	Facility		$44.48	$306.16	$504.68
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.44 / $11.24 / $14.81	Facility	26	$7.44	$11.24	$14.81
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $22.20 / $35.85 / $239.66	Facility	TC	$22.20	$35.85	$239.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $26.46 / $36.10 / $80.02	Professional		$26.46	$36.10	$80.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.33 / $9.47 / $39.10	Professional	26	$7.33	$9.47	$39.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.14 / $23.28 / $42.11	Professional	TC	$19.14	$23.28	$42.11
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $21.33 / $29.37 / $57.25	Professional		$21.33	$29.37	$57.25
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.12 / $8.51 / $11.49	Professional	26	$6.12	$8.51	$11.49
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $19.03 / $28.12 / $33.40	Professional	TC	$19.03	$28.12	$33.40
BCBS Facility/Professional Facility Modifier Low / Median / High Price $64.25 / $112.51 / $334.90	Facility		$64.25	$112.51	$334.90
BCBS Facility/Professional Professional Modifier Low / Median / High Price $10.65 / $37.94 / $66.73	Professional		$10.65	$37.94	$66.73
Cigna Facility/Professional Facility Modifier Low / Median / High Price $33.44 / $70.59 / $195.82	Facility		$33.44	$70.59	$195.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $25.81 / $42.88 / $61.68	Professional		$25.81	$42.88	$61.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $11.48 / $17.80	Professional	26	$7.08	$11.48	$17.80
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.14 / $31.11 / $45.77	Professional	TC	$19.14	$31.11	$45.77
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $37.69 / $54.77 / $142.99	Professional		$37.69	$54.77	$142.99
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.21 / $14.44 / $74.84	Professional	26	$10.21	$14.44	$74.84
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $26.93 / $38.61 / $92.62	Professional	TC	$26.93	$38.61	$92.62
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 $38.61 / $39.22 / $42.87	Professional		$38.61	$39.22	$42.87
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.10 / $10.41 / $11.06	Professional	26	$10.10	$10.41	$11.06
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $28.20 / $29.12 / $31.82	Professional	TC	$28.20	$29.12	$31.82
Molina Facility/Professional Professional Modifier Low / Median / High Price $11.57 / $32.34 / $44.85	Professional		$11.57	$32.34	$44.85
United Facility/Professional Professional Modifier Low / Median / High Price $29.61 / $39.14 / $58.84	Professional		$29.61	$39.14	$58.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.64 / $10.87 / $17.59	Professional	26	$8.64	$10.87	$17.59
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.46 / $27.29 / $42.86	Professional	TC	$20.46	$27.29	$42.86