Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.83 / $100.52 / $119.81	Facility	26	$64.83	$100.52	$119.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $167.85 / $232.78 / $394.26	Professional		$167.85	$232.78	$394.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.15 / $74.81 / $223.15	Professional	26	$55.15	$74.81	$223.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $100.33 / $171.36 / $227.00	Professional	TC	$100.33	$171.36	$227.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $108.73 / $153.37 / $156.96	Professional		$108.73	$153.37	$156.96
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $44.58 / $57.93 / $82.57	Professional	26	$44.58	$57.93	$82.57
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $85.98 / $85.98 / $85.98	Professional	TC	$85.98	$85.98	$85.98
BCBS Facility/Professional Professional Modifier Low / Median / High Price $76.54 / $188.59 / $361.53	Professional		$76.54	$188.59	$361.53
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $78.89 / $78.89 / $78.89	Facility	26	$78.89	$78.89	$78.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $163.88 / $261.61 / $470.51	Professional		$163.88	$261.61	$470.51
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.32 / $82.57 / $124.17	Professional	26	$51.32	$82.57	$124.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $99.55 / $169.19 / $341.86	Professional	TC	$99.55	$169.19	$341.86
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $183.05 / $291.73 / $1,099.68	Professional		$183.05	$291.73	$1,099.68
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $73.39 / $103.97 / $401.71	Professional	26	$73.39	$103.97	$401.71
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $114.35 / $179.38 / $676.26	Professional	TC	$114.35	$179.38	$676.26
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 $191.93 / $194.99 / $210.69	Professional		$191.93	$194.99	$210.69
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $73.58 / $75.34 / $79.51	Professional	26	$73.58	$75.34	$79.51
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $116.60 / $121.41 / $131.18	Professional	TC	$116.60	$121.41	$131.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $83.18 / $220.42	Professional		$32.34	$83.18	$220.42
United Facility/Professional Professional Modifier Low / Median / High Price $201.66 / $304.18 / $448.51	Professional		$201.66	$304.18	$448.51
United Facility/Professional Professional Modifier 26 Low / Median / High Price $62.29 / $78.38 / $133.16	Professional	26	$62.29	$78.38	$133.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $136.72 / $213.88 / $332.39	Professional	TC	$136.72	$213.88	$332.39