Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $103.25 / $202.83 / $478.40	Facility		$103.25	$202.83	$478.40
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.57 / $31.57 / $39.45	Facility	26	$23.57	$31.57	$39.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $108.66 / $134.71 / $238.67	Professional		$108.66	$134.71	$238.67
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.80 / $23.39 / $39.83	Professional	26	$11.80	$23.39	$39.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $95.35 / $109.01 / $189.87	Professional	TC	$95.35	$109.01	$189.87
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $107.71 / $107.71 / $123.20	Professional		$107.71	$107.71	$123.20
BCBS Facility/Professional Facility Modifier Low / Median / High Price $142.49 / $159.51 / $689.12	Facility		$142.49	$159.51	$689.12
BCBS Facility/Professional Professional Modifier Low / Median / High Price $27.17 / $86.24 / $243.79	Professional		$27.17	$86.24	$243.79
Cigna Facility/Professional Facility Modifier Low / Median / High Price $147.68 / $304.44 / $467.12	Facility		$147.68	$304.44	$467.12
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.75 / $26.75 / $26.75	Facility	26	$26.75	$26.75	$26.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $142.30 / $202.27 / $334.16	Professional		$142.30	$202.27	$334.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.82 / $28.11 / $48.40	Professional	26	$14.82	$28.11	$48.40
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $119.27 / $170.80 / $307.99	Professional	TC	$119.27	$170.80	$307.99
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $144.07 / $210.52 / $539.16	Professional		$144.07	$210.52	$539.16
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $21.58 / $34.29 / $114.34	Professional	26	$21.58	$34.29	$114.34
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $122.32 / $175.88 / $426.38	Professional	TC	$122.32	$175.88	$426.38
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 $170.26 / $172.93 / $190.54	Professional		$170.26	$172.93	$190.54
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.43 / $29.32 / $31.85	Professional	26	$26.43	$29.32	$31.85
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $140.96 / $146.50 / $158.69	Professional	TC	$140.96	$146.50	$158.69
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $168.08	Professional		$32.34	$32.34	$168.08
United Facility/Professional Professional Modifier Low / Median / High Price $144.01 / $207.85 / $324.89	Professional		$144.01	$207.85	$324.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.11 / $25.70 / $49.95	Professional	26	$14.11	$25.70	$49.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $120.87 / $185.78 / $286.68	Professional	TC	$120.87	$185.78	$286.68