Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $63.79 / $98.95 / $122.26	Facility	26	$63.79	$98.95	$122.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $210.98 / $300.00 / $478.42	Professional		$210.98	$300.00	$478.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.70 / $65.95 / $122.79	Professional	26	$59.70	$65.95	$122.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $151.18 / $212.93 / $375.83	Professional	TC	$151.18	$212.93	$375.83
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $142.65 / $142.65 / $235.68	Professional		$142.65	$142.65	$235.68
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $55.44 / $60.17 / $81.23	Professional	26	$55.44	$60.17	$81.23
BCBS Facility/Professional Professional Modifier Low / Median / High Price $75.31 / $246.67 / $473.44	Professional		$75.31	$246.67	$473.44
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $88.99 / $88.99 / $88.99	Facility	26	$88.99	$88.99	$88.99
Cigna Facility/Professional Professional Modifier Low / Median / High Price $214.60 / $341.20 / $610.82	Professional		$214.60	$341.20	$610.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.21 / $84.54 / $135.27	Professional	26	$52.21	$84.54	$135.27
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $151.29 / $253.31 / $471.54	Professional	TC	$151.29	$253.31	$471.54
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $240.81 / $373.40 / $1,461.89	Professional		$240.81	$373.40	$1,461.89
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $72.20 / $104.81 / $480.57	Professional	26	$72.20	$104.81	$480.57
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $272.60 / $1,057.30	Professional	TC	$173.78	$272.60	$1,057.30
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 $251.33 / $257.33 / $277.38	Professional		$251.33	$257.33	$277.38
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $72.34 / $74.15 / $78.22	Professional	26	$72.34	$74.15	$78.22
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $177.19 / $184.99 / $199.15	Professional	TC	$177.19	$184.99	$199.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $81.83 / $290.18	Professional		$32.34	$81.83	$290.18
United Facility/Professional Professional Modifier Low / Median / High Price $251.54 / $390.01 / $594.59	Professional		$251.54	$390.01	$594.59
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.22 / $81.12 / $130.18	Professional	26	$64.22	$81.12	$130.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $185.12 / $301.63 / $454.32	Professional	TC	$185.12	$301.63	$454.32