Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $98.40 / $575.16 / $1,147.20	Facility		$98.40	$575.16	$1,147.20
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.12 / $35.15 / $49.80	Facility	26	$25.12	$35.15	$49.80
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $57.29 / $176.67 / $786.51	Facility	TC	$57.29	$176.67	$786.51
Aetna Facility/Professional Professional Modifier Low / Median / High Price $76.93 / $118.49 / $422.00	Professional		$76.93	$118.49	$422.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.40 / $45.60 / $151.05	Professional	26	$25.40	$45.60	$151.05
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $49.90 / $71.45 / $153.44	Professional	TC	$49.90	$71.45	$153.44
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $56.62 / $68.06 / $106.61	Professional		$56.62	$68.06	$106.61
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $20.44 / $23.91 / $37.97	Professional	26	$20.44	$23.91	$37.97
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $50.22 / $71.08 / $81.23	Professional	TC	$50.22	$71.08	$81.23
BCBS Facility/Professional Facility Modifier Low / Median / High Price $149.63 / $311.61 / $883.79	Facility		$149.63	$311.61	$883.79
BCBS Facility/Professional Professional Modifier Low / Median / High Price $35.20 / $100.90 / $193.42	Professional		$35.20	$100.90	$193.42
Cigna Facility/Professional Facility Modifier Low / Median / High Price $107.07 / $183.09 / $304.44	Facility		$107.07	$183.09	$304.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $78.11 / $119.34 / $185.02	Professional		$78.11	$119.34	$185.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.98 / $38.25 / $56.25	Professional	26	$23.98	$38.25	$56.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $51.71 / $79.65 / $128.06	Professional	TC	$51.71	$79.65	$128.06
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $95.72 / $136.85 / $462.32	Professional		$95.72	$136.85	$462.32
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $31.08 / $45.01 / $157.86	Professional	26	$31.08	$45.01	$157.86
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $64.78 / $90.10 / $273.83	Professional	TC	$64.78	$90.10	$273.83
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 Facility Modifier TC Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	TC	$100.00	$100.00	$100.00
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $102.69 / $104.65 / $113.13	Professional		$102.69	$104.65	$113.13
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.68 / $34.61 / $36.57	Professional	26	$33.68	$34.61	$36.57
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $68.08 / $70.97 / $76.56	Professional	TC	$68.08	$70.97	$76.56
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $38.26 / $118.35	Professional		$32.34	$38.26	$118.35
United Facility/Professional Facility Modifier Low / Median / High Price $128.26 / $128.26 / $180.02	Facility		$128.26	$128.26	$180.02
United Facility/Professional Professional Modifier Low / Median / High Price $88.89 / $116.36 / $173.67	Professional		$88.89	$116.36	$173.67
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.42 / $38.01 / $70.27	Professional	26	$28.42	$38.01	$70.27
United Facility/Professional Professional Modifier TC Low / Median / High Price $59.60 / $81.54 / $125.62	Professional	TC	$59.60	$81.54	$125.62