Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $130.86 / $518.65 / $1,041.69	Facility		$130.86	$518.65	$1,041.69
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.53 / $25.31 / $27.92	Facility	26	$14.53	$25.31	$27.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.59 / $99.09 / $173.18	Professional		$81.59	$99.09	$173.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.64 / $15.04 / $36.69	Professional	26	$13.64	$15.04	$36.69
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $67.40 / $80.70 / $147.40	Professional	TC	$67.40	$80.70	$147.40
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $65.45 / $65.45 / $65.45	Professional		$65.45	$65.45	$65.45
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $11.53 / $11.72 / $19.62	Professional	26	$11.53	$11.72	$19.62
BCBS Facility/Professional Facility Modifier Low / Median / High Price $183.92 / $333.56 / $1,257.92	Facility		$183.92	$333.56	$1,257.92
BCBS Facility/Professional Professional Modifier Low / Median / High Price $19.23 / $69.38 / $222.65	Professional		$19.23	$69.38	$222.65
Cigna Facility/Professional Facility Modifier Low / Median / High Price $111.33 / $253.11 / $678.54	Facility		$111.33	$253.11	$678.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $75.92 / $119.35 / $187.47	Professional		$75.92	$119.35	$187.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.08 / $21.44 / $32.74	Professional	26	$13.08	$21.44	$32.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $63.94 / $102.69 / $160.25	Professional	TC	$63.94	$102.69	$160.25
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $111.18 / $161.71 / $493.16	Professional		$111.18	$161.71	$493.16
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.69 / $26.39 / $88.90	Professional	26	$18.69	$26.39	$88.90
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $92.57 / $137.12 / $419.37	Professional	TC	$92.57	$137.12	$419.37
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 $118.20 / $122.41 / $131.38	Professional		$118.20	$122.41	$131.38
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.85 / $19.05 / $19.98	Professional	26	$18.85	$19.05	$19.98
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $99.14 / $103.56 / $111.41	Professional	TC	$99.14	$103.56	$111.41
Molina Facility/Professional Professional Modifier Low / Median / High Price $20.90 / $32.34 / $137.46	Professional		$20.90	$32.34	$137.46
United Facility/Professional Facility Modifier Low / Median / High Price $18.89 / $201.58 / $203.07	Facility		$18.89	$201.58	$203.07
United Facility/Professional Professional Modifier Low / Median / High Price $88.32 / $116.79 / $181.28	Professional		$88.32	$116.79	$181.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.21 / $20.64 / $30.89	Professional	26	$16.21	$20.64	$30.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $71.31 / $95.11 / $152.30	Professional	TC	$71.31	$95.11	$152.30