Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.94 / $96.23 / $105.34	Facility	26	$56.94	$96.23	$105.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $151.28 / $232.72 / $328.53	Professional		$151.28	$232.72	$328.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.57 / $57.32 / $123.76	Professional	26	$48.57	$57.32	$123.76
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $96.63 / $162.71 / $240.00	Professional	TC	$96.63	$162.71	$240.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $62.24 / $90.12 / $194.95	Professional		$62.24	$90.12	$194.95
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $42.12 / $64.37 / $75.80	Professional	26	$42.12	$64.37	$75.80
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $50.78 / $50.78 / $50.78	Professional	TC	$50.78	$50.78	$50.78
BCBS Facility/Professional Professional Modifier Low / Median / High Price $67.13 / $175.80 / $320.14	Professional		$67.13	$175.80	$320.14
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $68.81 / $68.81 / $68.81	Facility	26	$68.81	$68.81	$68.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $144.50 / $231.39 / $426.27	Professional		$144.50	$231.39	$426.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.80 / $72.41 / $111.29	Professional	26	$44.80	$72.41	$111.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $91.08 / $151.77 / $308.87	Professional	TC	$91.08	$151.77	$308.87
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $170.83 / $272.23 / $984.07	Professional		$170.83	$272.23	$984.07
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.37 / $91.58 / $414.04	Professional	26	$64.37	$91.58	$414.04
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $110.59 / $173.48 / $659.78	Professional	TC	$110.59	$173.48	$659.78
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 $178.91 / $182.09 / $196.61	Professional		$178.91	$182.09	$196.61
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.70 / $66.14 / $69.73	Professional	26	$64.70	$66.14	$69.73
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $112.76 / $117.38 / $126.88	Professional	TC	$112.76	$117.38	$126.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $71.23 / $205.69	Professional		$32.34	$71.23	$205.69
United Facility/Professional Professional Modifier Low / Median / High Price $164.11 / $254.63 / $405.27	Professional		$164.11	$254.63	$405.27
United Facility/Professional Professional Modifier 26 Low / Median / High Price $55.35 / $70.95 / $117.54	Professional	26	$55.35	$70.95	$117.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $106.81 / $176.07 / $277.18	Professional	TC	$106.81	$176.07	$277.18