Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $302.00 / $309.03 / $512.86	Facility		$302.00	$309.03	$512.86
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $91.20 / $91.20	Facility	26	$91.20	$91.20	$91.20
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $213.80 / $213.80 / $213.80	Facility	TC	$213.80	$213.80	$213.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $123.03 / $512.86	Professional		$72.44	$123.03	$512.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $60.26 / $316.23	Professional	26	$28.18	$60.26	$316.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $69.18 / $223.87	Professional	TC	$48.98	$69.18	$223.87
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $51.29 / $51.29	Professional		$50.12	$51.29	$51.29
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $19.05 / $44.67	Professional	26	$15.85	$19.05	$44.67
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $36.31 / $36.31	Professional	TC	$36.31	$36.31	$36.31
BCBS Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $112.20 / $173.78	Professional		$34.67	$112.20	$173.78
Cigna Facility/Professional Facility Modifier Low / Median / High Price $53.70 / $53.70 / $125.89	Facility		$53.70	$53.70	$125.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $61.66 / $186.21	Professional		$47.86	$61.66	$186.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $24.55 / $58.88	Professional	26	$15.85	$24.55	$58.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $38.90 / $125.89	Professional	TC	$28.18	$38.90	$125.89
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $177.83 / $281.84	Professional		$112.20	$177.83	$281.84
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $56.23 / $251.19	Professional	26	$35.48	$56.23	$251.19
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $109.65 / $251.19	Professional	TC	$69.18	$109.65	$251.19
Molina Facility/Professional Professional Modifier Low / Median / High Price $11.22 / $32.36 / $33.11	Professional		$11.22	$32.36	$33.11
United Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $107.15 / $162.18	Professional		$66.07	$107.15	$162.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $38.90 / $57.54	Professional	26	$22.91	$38.90	$57.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $67.61 / $109.65	Professional	TC	$43.65	$67.61	$109.65