Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $111.38 / $708.11 / $1,383.41	Facility		$111.38	$708.11	$1,383.41
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.95 / $47.53 / $68.17	Facility	26	$33.95	$47.53	$68.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $102.22 / $162.54 / $531.86	Professional		$102.22	$162.54	$531.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.33 / $52.71 / $176.00	Professional	26	$34.33	$52.71	$176.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $65.30 / $91.86 / $183.46	Professional	TC	$65.30	$91.86	$183.46
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $74.94 / $88.74 / $171.71	Professional		$74.94	$88.74	$171.71
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.08 / $36.26 / $51.61	Professional	26	$28.08	$36.26	$51.61
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $51.04 / $65.84 / $106.08	Professional	TC	$51.04	$65.84	$106.08
BCBS Facility/Professional Facility Modifier Low / Median / High Price $165.77 / $433.18 / $1,467.94	Facility		$165.77	$433.18	$1,467.94
BCBS Facility/Professional Professional Modifier Low / Median / High Price $48.30 / $123.39 / $257.82	Professional		$48.30	$123.39	$257.82
Cigna Facility/Professional Facility Modifier Low / Median / High Price $129.72 / $216.58 / $348.36	Facility		$129.72	$216.58	$348.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $105.27 / $162.41 / $248.83	Professional		$105.27	$162.41	$248.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.82 / $53.72 / $77.69	Professional	26	$33.82	$53.72	$77.69
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $69.54 / $108.38 / $165.09	Professional	TC	$69.54	$108.38	$165.09
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $127.60 / $184.26 / $448.08	Professional		$127.60	$184.26	$448.08
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $42.64 / $61.74 / $230.69	Professional	26	$42.64	$61.74	$230.69
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $85.15 / $120.30 / $243.38	Professional	TC	$85.15	$120.30	$243.38
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 $136.88 / $139.13 / $150.80	Professional		$136.88	$139.13	$150.80
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $46.29 / $47.50 / $50.17	Professional	26	$46.29	$47.50	$50.17
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $89.36 / $92.83 / $100.63	Professional	TC	$89.36	$92.83	$100.63
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $52.48 / $157.76	Professional		$32.34	$52.48	$157.76
United Facility/Professional Professional Modifier Low / Median / High Price $118.85 / $150.41 / $230.74	Professional		$118.85	$150.41	$230.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.68 / $48.74 / $75.34	Professional	26	$37.68	$48.74	$75.34
United Facility/Professional Professional Modifier TC Low / Median / High Price $78.23 / $104.32 / $154.74	Professional	TC	$78.23	$104.32	$154.74