Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.57 / $102.33 / $181.97	Facility	26	$64.57	$102.33	$181.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $275.42 / $891.25	Professional		$162.18	$275.42	$891.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $104.71 / $234.42	Professional	26	$58.88	$104.71	$234.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $151.36 / $309.03	Professional	TC	$100.00	$151.36	$309.03
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $117.49 / $144.54	Professional		$114.82	$117.49	$144.54
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $56.23 / $75.86	Professional	26	$44.67	$56.23	$75.86
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $112.20 / $131.83	Professional	TC	$67.61	$112.20	$131.83
BCBS Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $190.55 / $363.08	Professional		$75.86	$190.55	$363.08
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.43 / $79.43 / $79.43	Facility	26	$79.43	$79.43	$79.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $275.42 / $489.78	Professional		$169.82	$275.42	$489.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $83.18 / $123.03	Professional	26	$51.29	$83.18	$123.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $177.83 / $371.54	Professional	TC	$102.33	$177.83	$371.54
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $354.81 / $1,258.93	Professional		$186.21	$354.81	$1,258.93
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $123.03 / $467.74	Professional	26	$72.44	$123.03	$467.74
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $229.09 / $933.25	Professional	TC	$114.82	$229.09	$933.25
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 $190.55 / $194.98 / $208.93	Professional		$190.55	$194.98	$208.93
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $75.86 / $79.43	Professional	26	$74.13	$75.86	$79.43
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $120.23 / $131.83	Professional	TC	$117.49	$120.23	$131.83
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 $190.55 / $281.84 / $426.58	Professional		$190.55	$281.84	$426.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $75.86 / $114.82	Professional	26	$57.54	$75.86	$114.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $208.93 / $331.13	Professional	TC	$123.03	$208.93	$331.13