Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $43.77 / $258.14 / $404.54	Facility		$43.77	$258.14	$404.54
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.74 / $10.95 / $15.41	Facility	26	$7.74	$10.95	$15.41
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $20.44 / $32.94 / $357.70	Facility	TC	$20.44	$32.94	$357.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $24.69 / $31.76 / $111.12	Professional		$24.69	$31.76	$111.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.00 / $11.92 / $52.80	Professional	26	$8.00	$11.92	$52.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.60 / $20.44 / $45.48	Professional	TC	$16.60	$20.44	$45.48
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $21.48 / $29.28 / $36.78	Professional		$21.48	$29.28	$36.78
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.42 / $8.74 / $11.92	Professional	26	$6.42	$8.74	$11.92
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $18.17 / $24.64 / $29.03	Professional	TC	$18.17	$24.64	$29.03
BCBS Facility/Professional Facility Modifier Low / Median / High Price $56.52 / $105.24 / $297.70	Facility		$56.52	$105.24	$297.70
BCBS Facility/Professional Professional Modifier Low / Median / High Price $11.05 / $34.96 / $67.01	Professional		$11.05	$34.96	$67.01
Cigna Facility/Professional Facility Modifier Low / Median / High Price $41.55 / $65.94 / $202.19	Facility		$41.55	$65.94	$202.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $23.88 / $37.90 / $56.72	Professional		$23.88	$37.90	$56.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.37 / $11.92 / $18.50	Professional	26	$7.37	$11.92	$18.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.55 / $26.35 / $40.20	Professional	TC	$16.55	$26.35	$40.20
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $34.90 / $51.56 / $170.54	Professional		$34.90	$51.56	$170.54
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.41 / $15.01 / $59.46	Professional	26	$10.41	$15.01	$59.46
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $22.58 / $33.81 / $118.15	Professional	TC	$22.58	$33.81	$118.15
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 $35.58 / $36.02 / $39.43	Professional		$35.58	$36.02	$39.43
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.53 / $10.83 / $11.48	Professional	26	$10.53	$10.83	$11.48
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $24.74 / $25.49 / $27.95	Professional	TC	$24.74	$25.49	$27.95
Molina Facility/Professional Professional Modifier Low / Median / High Price $12.01 / $32.34 / $41.25	Professional		$12.01	$32.34	$41.25
United Facility/Professional Professional Modifier Low / Median / High Price $27.67 / $35.51 / $54.86	Professional		$27.67	$35.51	$54.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.23 / $13.69 / $35.56	Professional	26	$9.23	$13.69	$35.56
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.21 / $24.45 / $39.45	Professional	TC	$18.21	$24.45	$39.45