Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $199.53 / $1,096.48 / $5,623.41	Facility		$199.53	$1,096.48	$5,623.41
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.90 / $67.61 / $75.86	Facility	26	$38.90	$67.61	$75.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $245.47 / $660.69	Professional		$151.36	$245.47	$660.69
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $61.66 / $181.97	Professional	26	$38.90	$61.66	$181.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $154.88 / $281.84	Professional	TC	$91.20	$154.88	$281.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $154.88 / $186.21	Professional		$120.23	$154.88	$186.21
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $45.71 / $51.29	Professional	26	$41.69	$45.71	$51.29
BCBS Facility/Professional Facility Modifier Low / Median / High Price $870.96 / $2,344.23 / $4,466.84	Facility		$870.96	$2,344.23	$4,466.84
BCBS Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $162.18 / $323.59	Professional		$46.77	$162.18	$323.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $234.42 / $338.84	Professional		$165.96	$234.42	$338.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $60.26 / $95.50	Professional	26	$41.69	$60.26	$95.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $169.82 / $263.03	Professional	TC	$117.49	$169.82	$263.03
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $269.15 / $691.83	Professional		$165.96	$269.15	$691.83
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $67.61 / $218.78	Professional	26	$42.66	$67.61	$218.78
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $194.98 / $489.78	Professional	TC	$131.83	$194.98	$489.78
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 $194.98 / $199.53 / $218.78	Professional		$194.98	$199.53	$218.78
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $48.98 / $52.48	Professional	26	$46.77	$48.98	$52.48
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $154.88 / $162.18	Professional	TC	$144.54	$154.88	$162.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $44.67 / $120.23	Professional		$26.30	$44.67	$120.23
United Facility/Professional Facility Modifier Low / Median / High Price $151.36 / $831.76 / $2,630.27	Facility		$151.36	$831.76	$2,630.27
United Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $213.80 / $346.74	Professional		$144.54	$213.80	$346.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $58.88 / $91.20	Professional	26	$41.69	$58.88	$91.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $154.88 / $257.04	Professional	TC	$100.00	$154.88	$257.04