Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.69 / $64.57 / $194.98	Facility	26	$41.69	$64.57	$194.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $199.53 / $741.31	Professional		$104.71	$199.53	$741.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $47.86 / $151.36	Professional	26	$36.31	$47.86	$151.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $114.82 / $281.84	Professional	TC	$64.57	$114.82	$281.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $81.28 / $109.65	Professional		$38.90	$81.28	$109.65
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $38.02 / $57.54	Professional	26	$30.20	$38.02	$57.54
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $74.13 / $93.33	Professional	TC	$45.71	$74.13	$93.33
BCBS Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $125.89 / $239.88	Professional		$51.29	$125.89	$239.88
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $51.29 / $51.29	Facility	26	$51.29	$51.29	$51.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $177.83 / $331.13	Professional		$104.71	$177.83	$331.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $56.23 / $83.18	Professional	26	$33.88	$56.23	$83.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $112.20 / $245.47	Professional	TC	$66.07	$112.20	$245.47
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $309.03 / $1,174.90	Professional		$125.89	$309.03	$1,174.90
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $81.28 / $380.19	Professional	26	$47.86	$81.28	$380.19
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $154.88 / $912.01	Professional	TC	$74.13	$154.88	$912.01
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 $128.82 / $131.83 / $141.25	Professional		$128.82	$131.83	$141.25
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $50.12 / $52.48	Professional	26	$48.98	$50.12	$52.48
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $83.18 / $89.13	Professional	TC	$79.43	$83.18	$89.13
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $33.11	Professional		$32.36	$33.11	$33.11
United Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $181.97 / $302.00	Professional		$112.20	$181.97	$302.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $50.12 / $77.62	Professional	26	$38.90	$50.12	$77.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $117.49 / $234.42	Professional	TC	$69.18	$117.49	$234.42