Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $113.02 / $523.41 / $1,106.23	Facility		$113.02	$523.41	$1,106.23
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.21 / $33.89 / $47.44	Facility	26	$24.21	$33.89	$47.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $97.44 / $152.77 / $422.69	Professional		$97.44	$152.77	$422.69
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.07 / $41.80 / $147.08	Professional	26	$24.07	$41.80	$147.08
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $45.68 / $53.26 / $93.43	Professional	52	$45.68	$53.26	$93.43
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $69.98 / $94.28 / $262.08	Professional	TC	$69.98	$94.28	$262.08
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $71.17 / $84.04 / $140.82	Professional		$71.17	$84.04	$140.82
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $19.72 / $24.85 / $35.82	Professional	26	$19.72	$24.85	$35.82
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $70.38 / $99.25 / $99.47	Professional	TC	$70.38	$99.25	$99.47
BCBS Facility/Professional Facility Modifier Low / Median / High Price $149.63 / $344.76 / $1,256.51	Facility		$149.63	$344.76	$1,256.51
BCBS Facility/Professional Professional Modifier Low / Median / High Price $33.97 / $107.62 / $242.71	Professional		$33.97	$107.62	$242.71
Cigna Facility/Professional Facility Modifier Low / Median / High Price $139.19 / $231.95 / $372.19	Facility		$139.19	$231.95	$372.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $91.40 / $148.31 / $213.16	Professional		$91.40	$148.31	$213.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.33 / $36.82 / $54.12	Professional	26	$23.33	$36.82	$54.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $61.27 / $111.66 / $165.42	Professional	TC	$61.27	$111.66	$165.42
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $111.94 / $164.79 / $500.34	Professional		$111.94	$164.79	$500.34
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $29.93 / $43.43 / $245.04	Professional	26	$29.93	$43.43	$245.04
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $80.81 / $117.54 / $260.04	Professional	TC	$80.81	$117.54	$260.04
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 $128.84 / $131.69 / $142.82	Professional		$128.84	$131.69	$142.82
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.42 / $33.35 / $35.29	Professional	26	$32.42	$33.35	$35.29
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $99.27 / $107.52	Professional	TC	$95.50	$99.27	$107.52
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $36.92 / $149.41	Professional		$32.34	$36.92	$149.41
United Facility/Professional Facility Modifier Low / Median / High Price $28.75 / $85.13 / $180.02	Facility		$28.75	$85.13	$180.02
United Facility/Professional Professional Modifier Low / Median / High Price $104.76 / $137.10 / $220.74	Professional		$104.76	$137.10	$220.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.98 / $34.14 / $53.36	Professional	26	$25.98	$34.14	$53.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $101.81 / $162.02	Professional	TC	$77.62	$101.81	$162.02