Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.43 / $131.83 / $229.09	Facility	26	$79.43	$131.83	$229.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $338.84 / $1,318.26	Professional		$218.78	$338.84	$1,318.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $104.71 / $239.88	Professional	26	$64.57	$104.71	$239.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $213.80 / $467.74	Professional	TC	$144.54	$213.80	$467.74
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $169.82 / $186.21	Professional		$144.54	$169.82	$186.21
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $57.54 / $104.71	Professional	26	$56.23	$57.54	$104.71
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $112.20 / $177.83	Professional	TC	$112.20	$112.20	$177.83
BCBS Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $234.42 / $501.19	Professional		$95.50	$234.42	$501.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $89.13 / $89.13	Facility	26	$89.13	$89.13	$89.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $354.81 / $630.96	Professional		$229.09	$354.81	$630.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $97.72 / $147.91	Professional	26	$63.10	$97.72	$147.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $239.88 / $457.09	Professional	TC	$144.54	$239.88	$457.09
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $489.78 / $1,737.80	Professional		$251.19	$489.78	$1,737.80
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $147.91 / $676.08	Professional	26	$91.20	$147.91	$676.08
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $346.74 / $1,174.90	Professional	TC	$169.82	$346.74	$1,174.90
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 $263.03 / $269.15 / $295.12	Professional		$263.03	$269.15	$295.12
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $95.50 / $100.00	Professional	26	$93.33	$95.50	$100.00
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $177.83 / $190.55	Professional	TC	$169.82	$177.83	$190.55
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 $234.42 / $354.81 / $524.81	Professional		$234.42	$354.81	$524.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $91.20 / $147.91	Professional	26	$70.79	$91.20	$147.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $257.04 / $426.58	Professional	TC	$158.49	$257.04	$426.58