Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $149.05 / $724.68 / $1,180.30	Facility		$149.05	$724.68	$1,180.30
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.10 / $29.53 / $37.85	Facility	26	$21.10	$29.53	$37.85
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $99.56 / $249.75 / $678.56	Facility	TC	$99.56	$249.75	$678.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.63 / $130.50 / $370.62	Professional		$30.63	$130.50	$370.62
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.62 / $31.20 / $106.00	Professional	26	$20.62	$31.20	$106.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $88.84 / $106.95 / $207.90	Professional	TC	$88.84	$106.95	$207.90
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $78.73 / $92.11 / $134.94	Professional		$78.73	$92.11	$134.94
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $15.24 / $17.78 / $27.84	Professional	26	$15.24	$17.78	$27.84
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $71.40 / $115.01 / $133.49	Professional	TC	$71.40	$115.01	$133.49
BCBS Facility/Professional Facility Modifier Low / Median / High Price $160.72 / $478.28 / $1,572.97	Facility		$160.72	$478.28	$1,572.97
BCBS Facility/Professional Professional Modifier Low / Median / High Price $23.57 / $76.59 / $207.93	Professional		$23.57	$76.59	$207.93
Cigna Facility/Professional Facility Modifier Low / Median / High Price $155.90 / $302.05 / $910.07	Facility		$155.90	$302.05	$910.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.99 / $165.92 / $261.02	Professional		$114.99	$165.92	$261.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.85 / $29.30 / $44.60	Professional	26	$20.85	$29.30	$44.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $95.95 / $137.38 / $214.82	Professional	TC	$95.95	$137.38	$214.82
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $127.76 / $183.71 / $492.14	Professional		$127.76	$183.71	$492.14
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $23.38 / $32.58 / $170.93	Professional	26	$23.38	$32.58	$170.93
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $95.08 / $136.18 / $275.81	Professional	TC	$95.08	$136.18	$275.81
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 $138.41 / $141.96 / $154.08	Professional		$138.41	$141.96	$154.08
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $24.97 / $26.04 / $27.63	Professional	26	$24.97	$26.04	$27.63
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $112.37 / $116.99 / $126.45	Professional	TC	$112.37	$116.99	$126.45
Molina Facility/Professional Professional Modifier Low / Median / High Price $28.90 / $32.34 / $161.19	Professional		$28.90	$32.34	$161.19
United Facility/Professional Professional Modifier Low / Median / High Price $120.11 / $166.12 / $271.62	Professional		$120.11	$166.12	$271.62
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.67 / $33.74 / $57.20	Professional	26	$21.67	$33.74	$57.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $99.32 / $150.05 / $242.98	Professional	TC	$99.32	$150.05	$242.98