Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $356.49 / $1,188.46 / $3,063.51	Facility		$356.49	$1,188.46	$3,063.51
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $73.42 / $101.26 / $150.55	Facility	26	$73.42	$101.26	$150.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $186.46 / $263.27 / $925.00	Professional		$186.46	$263.27	$925.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.86 / $77.45 / $277.48	Professional	26	$63.86	$77.45	$277.48
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $129.05 / $180.34 / $486.83	Professional	TC	$129.05	$180.34	$486.83
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $126.12 / $172.86 / $232.50	Professional		$126.12	$172.86	$232.50
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $62.34 / $71.48 / $88.42	Professional	26	$62.34	$71.48	$88.42
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $95.53 / $95.53 / $95.53	Professional	TC	$95.53	$95.53	$95.53
BCBS Facility/Professional Facility Modifier Low / Median / High Price $668.80 / $1,019.92 / $2,717.18	Facility		$668.80	$1,019.92	$2,717.18
BCBS Facility/Professional Professional Modifier Low / Median / High Price $74.72 / $183.53 / $389.96	Professional		$74.72	$183.53	$389.96
Cigna Facility/Professional Facility Modifier Low / Median / High Price $720.44 / $1,527.66 / $4,527.00	Facility		$720.44	$1,527.66	$4,527.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $194.77 / $290.63 / $432.05	Professional		$194.77	$290.63	$432.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.34 / $94.28 / $133.35	Professional	26	$69.34	$94.28	$133.35
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $132.93 / $193.36 / $301.68	Professional	TC	$132.93	$193.36	$301.68
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $207.54 / $304.06 / $867.99	Professional		$207.54	$304.06	$867.99
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $74.11 / $105.94 / $417.28	Professional	26	$74.11	$105.94	$417.28
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $134.22 / $189.57 / $481.95	Professional	TC	$134.22	$189.57	$481.95
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 $229.59 / $234.61 / $251.88	Professional		$229.59	$234.61	$251.88
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $82.88 / $83.66 / $87.58	Professional	26	$82.88	$83.66	$87.58
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $145.94 / $151.72 / $164.29	Professional	TC	$145.94	$151.72	$164.29
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $91.62 / $263.50	Professional		$32.34	$91.62	$263.50
United Facility/Professional Professional Modifier Low / Median / High Price $204.19 / $306.13 / $456.90	Professional		$204.19	$306.13	$456.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $68.44 / $94.76 / $149.30	Professional	26	$68.44	$94.76	$149.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $135.24 / $199.30 / $319.16	Professional	TC	$135.24	$199.30	$319.16