Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $237.36 / $810.60 / $1,237.59	Facility		$237.36	$810.60	$1,237.59
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.86 / $63.01 / $67.26	Facility	26	$37.86	$63.01	$67.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $165.68 / $204.25 / $432.65	Professional		$165.68	$204.25	$432.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.83 / $40.81 / $85.70	Professional	26	$30.83	$40.81	$85.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $130.53 / $167.34 / $265.99	Professional	TC	$130.53	$167.34	$265.99
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $139.57 / $152.76 / $175.58	Professional		$139.57	$152.76	$175.58
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.98 / $49.40 / $55.37	Professional	26	$28.98	$49.40	$55.37
BCBS Facility/Professional Facility Modifier Low / Median / High Price $389.36 / $822.70 / $2,825.90	Facility		$389.36	$822.70	$2,825.90
BCBS Facility/Professional Professional Modifier Low / Median / High Price $45.66 / $144.32 / $318.83	Professional		$45.66	$144.32	$318.83
Cigna Facility/Professional Facility Modifier Low / Median / High Price $241.62 / $438.61 / $916.00	Facility		$241.62	$438.61	$916.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $180.75 / $253.43 / $388.83	Professional		$180.75	$253.43	$388.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.64 / $52.68 / $76.59	Professional	26	$35.64	$52.68	$76.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $139.34 / $200.86 / $319.64	Professional	TC	$139.34	$200.86	$319.64
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $192.11 / $279.13 / $628.76	Professional		$192.11	$279.13	$628.76
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.81 / $60.37 / $193.73	Professional	26	$43.81	$60.37	$193.73
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $150.65 / $215.81 / $443.83	Professional	TC	$150.65	$215.81	$443.83
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 $212.24 / $214.01 / $237.17	Professional		$212.24	$214.01	$237.17
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $44.16 / $49.05 / $53.52	Professional	26	$44.16	$49.05	$53.52
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $163.19 / $169.83 / $183.65	Professional	TC	$163.19	$169.83	$183.65
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $52.82 / $248.12	Professional		$32.34	$52.82	$248.12
United Facility/Professional Professional Modifier Low / Median / High Price $191.39 / $271.87 / $405.82	Professional		$191.39	$271.87	$405.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.17 / $47.39 / $85.58	Professional	26	$35.17	$47.39	$85.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $150.19 / $215.55 / $354.55	Professional	TC	$150.19	$215.55	$354.55