Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $103.87 / $575.64 / $1,143.56	Facility		$103.87	$575.64	$1,143.56
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.98 / $46.53 / $62.31	Facility	26	$31.98	$46.53	$62.31
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $70.53 / $138.24 / $698.25	Facility	TC	$70.53	$138.24	$698.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $94.76 / $146.49 / $530.40	Professional		$94.76	$146.49	$530.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.36 / $52.50 / $151.72	Professional	26	$31.36	$52.50	$151.72
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $44.97 / $51.94 / $93.25	Professional	52	$44.97	$51.94	$93.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.45 / $87.95 / $180.83	Professional	TC	$61.45	$87.95	$180.83
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $70.09 / $80.54 / $104.84	Professional		$70.09	$80.54	$104.84
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.59 / $30.68 / $46.60	Professional	26	$25.59	$30.68	$46.60
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $53.55 / $87.73 / $100.15	Professional	TC	$53.55	$87.73	$100.15
BCBS Facility/Professional Facility Modifier Low / Median / High Price $165.77 / $393.38 / $1,087.58	Facility		$165.77	$393.38	$1,087.58
BCBS Facility/Professional Professional Modifier Low / Median / High Price $44.20 / $115.34 / $240.72	Professional		$44.20	$115.34	$240.72
Cigna Facility/Professional Facility Modifier Low / Median / High Price $120.81 / $202.13 / $329.00	Facility		$120.81	$202.13	$329.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $96.64 / $149.87 / $229.86	Professional		$96.64	$149.87	$229.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.80 / $48.09 / $70.64	Professional	26	$29.80	$48.09	$70.64
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $64.30 / $101.27 / $155.80	Professional	TC	$64.30	$101.27	$155.80
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $119.27 / $172.03 / $453.08	Professional		$119.27	$172.03	$453.08
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.89 / $56.51 / $191.54	Professional	26	$38.89	$56.51	$191.54
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $77.89 / $110.35 / $287.57	Professional	TC	$77.89	$110.35	$287.57
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 $127.79 / $129.74 / $140.96	Professional		$127.79	$129.74	$140.96
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $42.13 / $43.41 / $45.92	Professional	26	$42.13	$43.41	$45.92
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $84.38 / $87.61 / $95.04	Professional	TC	$84.38	$87.61	$95.04
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $48.04 / $147.46	Professional		$32.34	$48.04	$147.46
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 $110.26 / $144.31 / $213.69	Professional		$110.26	$144.31	$213.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.86 / $44.77 / $68.87	Professional	26	$33.86	$44.77	$68.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $75.58 / $101.15 / $142.34	Professional	TC	$75.58	$101.15	$142.34