Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $147.38 / $560.35 / $954.62	Facility		$147.38	$560.35	$954.62
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.92 / $40.24 / $47.53	Facility	26	$25.92	$40.24	$47.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $67.84 / $111.26 / $267.12	Professional		$67.84	$111.26	$267.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.78 / $33.69 / $73.67	Professional	26	$23.78	$33.69	$73.67
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $49.89 / $85.34 / $121.83	Professional	TC	$49.89	$85.34	$121.83
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $136.62 / $136.62 / $136.62	Professional		$136.62	$136.62	$136.62
BCBS Facility/Professional Facility Modifier Low / Median / High Price $147.71 / $259.95 / $1,301.44	Facility		$147.71	$259.95	$1,301.44
BCBS Facility/Professional Professional Modifier Low / Median / High Price $33.57 / $107.12 / $251.59	Professional		$33.57	$107.12	$251.59
Cigna Facility/Professional Facility Modifier Low / Median / High Price $85.66 / $85.66 / $85.66	Facility		$85.66	$85.66	$85.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $83.92 / $153.69 / $202.65	Professional		$83.92	$153.69	$202.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.28 / $37.56 / $53.51	Professional	26	$26.28	$37.56	$53.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $57.16 / $116.16 / $152.28	Professional	TC	$57.16	$116.16	$152.28
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $125.24 / $164.38 / $427.33	Professional		$125.24	$164.38	$427.33
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $40.47 / $162.32	Professional	26	$29.51	$40.47	$162.32
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $86.88 / $118.48 / $259.93	Professional	TC	$86.88	$118.48	$259.93
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 $133.56 / $137.15 / $148.01	Professional		$133.56	$137.15	$148.01
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $31.98 / $32.89 / $34.88	Professional	26	$31.98	$32.89	$34.88
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $96.16 / $100.67 / $113.13	Professional	TC	$96.16	$100.67	$113.13
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $39.44 / $167.36	Professional		$32.34	$39.44	$167.36
United Facility/Professional Professional Modifier Low / Median / High Price $79.31 / $130.46 / $206.00	Professional		$79.31	$130.46	$206.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.09 / $33.86 / $53.68	Professional	26	$27.09	$33.86	$53.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $51.22 / $91.00 / $152.32	Professional	TC	$51.22	$91.00	$152.32