Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $103.01 / $116.81 / $873.28	Facility		$103.01	$116.81	$873.28
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.55 / $29.43 / $40.65	Facility	26	$18.55	$29.43	$40.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $60.14 / $74.75 / $166.05	Professional		$60.14	$74.75	$166.05
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.90 / $18.50 / $28.45	Professional	26	$15.90	$18.50	$28.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.56 / $54.36 / $145.75	Professional	TC	$43.56	$54.36	$145.75
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $59.52 / $59.52 / $59.52	Professional		$59.52	$59.52	$59.52
BCBS Facility/Professional Facility Modifier Low / Median / High Price $95.09 / $315.83 / $665.69	Facility		$95.09	$315.83	$665.69
BCBS Facility/Professional Professional Modifier Low / Median / High Price $19.97 / $56.29 / $105.77	Professional		$19.97	$56.29	$105.77
Cigna Facility/Professional Facility Modifier Low / Median / High Price $75.31 / $401.02 / $869.17	Facility		$75.31	$401.02	$869.17
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.65 / $20.65 / $20.65	Facility	26	$20.65	$20.65	$20.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $63.82 / $100.95 / $256.98	Professional		$63.82	$100.95	$256.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.37 / $25.21 / $40.11	Professional	26	$18.37	$25.21	$40.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $44.76 / $74.36 / $211.49	Professional	TC	$44.76	$74.36	$211.49
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $62.70 / $95.54 / $229.98	Professional		$62.70	$95.54	$229.98
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.79 / $27.02 / $82.97	Professional	26	$18.79	$27.02	$82.97
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $44.76 / $67.81 / $153.22	Professional	TC	$44.76	$67.81	$153.22
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 $72.91 / $77.62 / $85.77	Professional		$72.91	$77.62	$85.77
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.89 / $22.10 / $23.41	Professional	26	$19.89	$22.10	$23.41
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $53.01 / $55.42 / $62.36	Professional	TC	$53.01	$55.42	$62.36
Molina Facility/Professional Professional Modifier Low / Median / High Price $24.49 / $32.34 / $89.73	Professional		$24.49	$32.34	$89.73
United Facility/Professional Professional Modifier Low / Median / High Price $65.95 / $117.20 / $182.12	Professional		$65.95	$117.20	$182.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.22 / $25.07 / $41.36	Professional	26	$17.22	$25.07	$41.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $46.81 / $91.39 / $145.82	Professional	TC	$46.81	$91.39	$145.82