Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $249.39 / $767.79 / $1,721.03	Facility		$249.39	$767.79	$1,721.03
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.75 / $55.14 / $66.15	Facility	26	$36.75	$55.14	$66.15
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $187.12 / $305.38 / $677.11	Facility	TC	$187.12	$305.38	$677.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $178.49 / $258.70 / $469.81	Professional		$178.49	$258.70	$469.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.51 / $39.72 / $115.41	Professional	26	$28.51	$39.72	$115.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.34 / $210.47 / $345.46	Professional	TC	$162.34	$210.47	$345.46
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $152.46 / $180.01 / $257.07	Professional		$152.46	$180.01	$257.07
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $26.99 / $29.01 / $45.50	Professional	26	$26.99	$29.01	$45.50
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $146.22 / $146.22 / $146.22	Professional	TC	$146.22	$146.22	$146.22
BCBS Facility/Professional Facility Modifier Low / Median / High Price $302.80 / $852.00 / $3,507.33	Facility		$302.80	$852.00	$3,507.33
BCBS Facility/Professional Professional Modifier Low / Median / High Price $42.05 / $136.32 / $415.30	Professional		$42.05	$136.32	$415.30
Cigna Facility/Professional Facility Modifier Low / Median / High Price $350.78 / $597.23 / $985.29	Facility		$350.78	$597.23	$985.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $229.91 / $320.06 / $496.73	Professional		$229.91	$320.06	$496.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.33 / $49.29 / $70.90	Professional	26	$31.33	$49.29	$70.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $196.49 / $278.83 / $438.45	Professional	TC	$196.49	$278.83	$438.45
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $238.23 / $345.40 / $718.47	Professional		$238.23	$345.40	$718.47
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $40.14 / $57.02 / $204.03	Professional	26	$40.14	$57.02	$204.03
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $203.37 / $283.23 / $561.32	Professional	TC	$203.37	$283.23	$561.32
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 $276.45 / $283.73 / $308.20	Professional		$276.45	$283.73	$308.20
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $44.14 / $46.33 / $49.30	Professional	26	$44.14	$46.33	$49.30
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $230.13 / $239.59 / $258.92	Professional	TC	$230.13	$239.59	$258.92
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $51.57 / $322.43	Professional		$32.34	$51.57	$322.43
United Facility/Professional Professional Modifier Low / Median / High Price $235.42 / $358.34 / $529.74	Professional		$235.42	$358.34	$529.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.54 / $45.77 / $83.05	Professional	26	$31.54	$45.77	$83.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $207.76 / $305.12 / $492.18	Professional	TC	$207.76	$305.12	$492.18