Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.69 / $60.26 / $123.03	Facility	26	$41.69	$60.26	$123.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $251.19 / $870.96	Professional		$131.83	$251.19	$870.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $64.57 / $199.53	Professional	26	$38.02	$64.57	$199.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $151.36 / $338.84	Professional	TC	$89.13	$151.36	$338.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $114.82 / $194.98	Professional		$89.13	$114.82	$194.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $38.02 / $58.88	Professional	26	$30.20	$38.02	$58.88
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $79.43 / $123.03	Professional	TC	$40.74	$79.43	$123.03
BCBS Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $128.82 / $281.84	Professional		$51.29	$128.82	$281.84
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.18 / $69.18 / $69.18	Facility	26	$69.18	$69.18	$69.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $213.80 / $398.11	Professional		$128.82	$213.80	$398.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $60.26 / $97.72	Professional	26	$35.48	$60.26	$97.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $144.54 / $295.12	Professional	TC	$87.10	$144.54	$295.12
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $323.59 / $1,023.29	Professional		$151.36	$323.59	$1,023.29
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $89.13 / $457.09	Professional	26	$47.86	$89.13	$457.09
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $177.83 / $776.25	Professional	TC	$93.33	$177.83	$776.25
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 $154.88 / $158.49 / $169.82	Professional		$154.88	$158.49	$169.82
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $50.12 / $53.70	Professional	26	$48.98	$50.12	$53.70
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $107.15 / $114.82	Professional	TC	$102.33	$107.15	$114.82
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 $134.90 / $223.87 / $354.81	Professional		$134.90	$223.87	$354.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $57.54 / $83.18	Professional	26	$41.69	$57.54	$83.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $154.88 / $275.42	Professional	TC	$91.20	$154.88	$275.42