Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.97 / $125.88 / $150.13	Facility	26	$80.97	$125.88	$150.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $222.61 / $340.04 / $543.33	Professional		$222.61	$340.04	$543.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.17 / $81.64 / $150.01	Professional	26	$62.17	$81.64	$150.01
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $146.41 / $244.93 / $376.36	Professional	TC	$146.41	$244.93	$376.36
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $133.76 / $175.82 / $225.10	Professional		$133.76	$175.82	$225.10
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $54.69 / $63.83 / $84.96	Professional	26	$54.69	$63.83	$84.96
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $112.79 / $112.79 / $112.79	Professional	TC	$112.79	$112.79	$112.79
BCBS Facility/Professional Professional Modifier Low / Median / High Price $95.77 / $246.67 / $500.09	Professional		$95.77	$246.67	$500.09
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 $226.68 / $346.01 / $567.16	Professional		$226.68	$346.01	$567.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.17 / $99.49 / $147.01	Professional	26	$63.17	$99.49	$147.01
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $146.05 / $230.92 / $438.04	Professional	TC	$146.05	$230.92	$438.04
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $254.04 / $392.75 / $1,425.86	Professional		$254.04	$392.75	$1,425.86
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $91.84 / $130.10 / $595.91	Professional	26	$91.84	$130.10	$595.91
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $167.76 / $263.16 / $1,008.63	Professional	TC	$167.76	$263.16	$1,008.63
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 $265.49 / $270.99 / $291.76	Professional		$265.49	$270.99	$291.76
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $92.44 / $94.43 / $99.49	Professional	26	$92.44	$94.43	$99.49
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $171.05 / $178.56 / $192.27	Professional	TC	$171.05	$178.56	$192.27
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $104.08 / $305.22	Professional		$32.34	$104.08	$305.22
United Facility/Professional Professional Modifier Low / Median / High Price $246.72 / $366.70 / $558.61	Professional		$246.72	$366.70	$558.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $74.02 / $93.08 / $156.97	Professional	26	$74.02	$93.08	$156.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $163.44 / $269.63 / $407.61	Professional	TC	$163.44	$269.63	$407.61