Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $41.69 / $275.42 / $512.86	Facility		$41.69	$275.42	$512.86
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.41 / $11.22 / $25.70	Facility	26	$7.41	$11.22	$25.70
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $22.39 / $40.74 / $234.42	Facility	TC	$22.39	$40.74	$234.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $45.71 / $141.25	Professional		$26.92	$45.71	$141.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $12.88 / $34.67	Professional	26	$7.08	$12.88	$34.67
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $28.84 / $54.95	Professional	TC	$19.05	$28.84	$54.95
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $23.44 / $44.67	Professional		$19.95	$23.44	$44.67
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.17 / $7.94 / $12.02	Professional	26	$6.17	$7.94	$12.02
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $19.50 / $29.51	Professional	TC	$15.14	$19.50	$29.51
BCBS Facility/Professional Facility Modifier Low / Median / High Price $64.57 / $117.49 / $281.84	Facility		$64.57	$117.49	$281.84
BCBS Facility/Professional Professional Modifier Low / Median / High Price $10.72 / $38.02 / $66.07	Professional		$10.72	$38.02	$66.07
Cigna Facility/Professional Facility Modifier Low / Median / High Price $23.44 / $53.70 / $131.83	Facility		$23.44	$53.70	$131.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $40.74 / $58.88	Professional		$25.70	$40.74	$58.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $11.48 / $16.98	Professional	26	$7.08	$11.48	$16.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $29.51 / $45.71	Professional	TC	$19.05	$29.51	$45.71
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $75.86 / $162.18	Professional		$38.02	$75.86	$162.18
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $17.38 / $89.13	Professional	26	$10.00	$17.38	$89.13
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $39.81 / $107.15	Professional	TC	$26.30	$39.81	$107.15
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 $38.90 / $38.90 / $42.66	Professional		$38.90	$38.90	$42.66
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 $28.18 / $28.84 / $31.62	Professional	TC	$28.18	$28.84	$31.62
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 $19.05 / $74.13 / $229.09	Facility		$19.05	$74.13	$229.09
United Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $36.31 / $54.95	Professional		$28.18	$36.31	$54.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $10.47 / $15.85	Professional	26	$8.13	$10.47	$15.85
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $26.30 / $39.81	Professional	TC	$19.50	$26.30	$39.81