Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $676.08 / $1,412.54	Facility		$112.20	$676.08	$1,412.54
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.88 / $45.71 / $104.71	Facility	26	$33.88	$45.71	$104.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $190.55 / $562.34	Professional		$100.00	$190.55	$562.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $58.88 / $165.96	Professional	26	$35.48	$58.88	$165.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $100.00 / $213.80	Professional	TC	$64.57	$100.00	$213.80
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $87.10 / $117.49	Professional		$72.44	$87.10	$117.49
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $36.31 / $69.18	Professional	26	$28.84	$36.31	$69.18
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $66.07 / $128.82	Professional	TC	$47.86	$66.07	$128.82
BCBS Facility/Professional Facility Modifier Low / Median / High Price $151.36 / $407.38 / $1,445.44	Facility		$151.36	$407.38	$1,445.44
BCBS Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $114.82 / $257.04	Professional		$47.86	$114.82	$257.04
Cigna Facility/Professional Facility Modifier Low / Median / High Price $75.86 / $186.21 / $346.74	Facility		$75.86	$186.21	$346.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $158.49 / $251.19	Professional		$102.33	$158.49	$251.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $52.48 / $77.62	Professional	26	$32.36	$52.48	$77.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $107.15 / $173.78	Professional	TC	$67.61	$107.15	$173.78
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $208.93 / $588.84	Professional		$128.82	$208.93	$588.84
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $69.18 / $245.47	Professional	26	$43.65	$69.18	$245.47
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $131.83 / $316.23	Professional	TC	$85.11	$131.83	$316.23
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 $138.04 / $138.04 / $151.36	Professional		$138.04	$138.04	$151.36
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $47.86 / $50.12	Professional	26	$46.77	$47.86	$50.12
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $93.33 / $100.00	Professional	TC	$89.13	$93.33	$100.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $33.11	Professional		$32.36	$33.11	$33.11
United Facility/Professional Facility Modifier Low / Median / High Price $77.62 / $89.13 / $275.42	Facility		$77.62	$89.13	$275.42
United Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $147.91 / $213.80	Professional		$114.82	$147.91	$213.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $46.77 / $74.13	Professional	26	$37.15	$46.77	$74.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $100.00 / $144.54	Professional	TC	$75.86	$100.00	$144.54