Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $52.48 / $660.69 / $1,148.15	Facility		$52.48	$660.69	$1,148.15
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.92 / $46.77 / $91.20	Facility	26	$26.92	$46.77	$91.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $95.50 / $389.05	Professional		$50.12	$95.50	$389.05
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $47.86 / $134.90	Professional	26	$28.18	$47.86	$134.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $37.15 / $181.97	Professional	TC	$21.88	$37.15	$181.97
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $50.12 / $100.00	Professional		$41.69	$50.12	$100.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $31.62 / $45.71	Professional	26	$22.39	$31.62	$45.71
BCBS Facility/Professional Facility Modifier Low / Median / High Price $154.88 / $407.38 / $812.83	Facility		$154.88	$407.38	$812.83
BCBS Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $70.79 / $134.90	Professional		$38.02	$70.79	$134.90
Cigna Facility/Professional Facility Modifier Low / Median / High Price $295.12 / $295.12 / $295.12	Facility		$295.12	$295.12	$295.12
Cigna Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $91.20 / $251.19	Professional		$51.29	$91.20	$251.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $42.66 / $64.57	Professional	26	$26.92	$42.66	$64.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $43.65 / $208.93	Professional	TC	$23.44	$43.65	$208.93
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $144.54 / $575.44	Professional		$69.18	$144.54	$575.44
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $54.95 / $371.54	Professional	26	$34.67	$54.95	$371.54
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $60.26 / $588.84	Professional	TC	$32.36	$60.26	$588.84
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 Professional Modifier Low / Median / High Price $70.79 / $70.79 / $77.62	Professional		$70.79	$70.79	$77.62
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $37.15 / $39.81	Professional	26	$36.31	$37.15	$39.81
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $34.67 / $38.02	Professional	TC	$33.88	$34.67	$38.02
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 $20.42 / $53.70 / $147.91	Facility		$20.42	$53.70	$147.91
United Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $89.13 / $234.42	Professional		$57.54	$89.13	$234.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $38.02 / $57.54	Professional	26	$30.20	$38.02	$57.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $38.90 / $190.55	Professional	TC	$24.55	$38.90	$190.55