Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.61 / $114.82 / $194.98	Facility	26	$67.61	$114.82	$194.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $426.58 / $1,380.38	Professional		$239.88	$426.58	$1,380.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $117.49 / $281.84	Professional	26	$64.57	$117.49	$281.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $295.12 / $562.34	Professional	TC	$173.78	$295.12	$562.34
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $199.53 / $204.17	Professional		$169.82	$199.53	$204.17
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $63.10 / $77.62	Professional	26	$46.77	$63.10	$77.62
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $123.03 / $123.03	Professional	TC	$123.03	$123.03	$123.03
BCBS Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $263.03 / $512.86	Professional		$79.43	$263.03	$512.86
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $83.18 / $83.18 / $83.18	Facility	26	$83.18	$83.18	$83.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $416.87 / $758.58	Professional		$229.09	$416.87	$758.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $91.20 / $141.25	Professional	26	$53.70	$91.20	$141.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $295.12 / $630.96	Professional	TC	$162.18	$295.12	$630.96
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $616.60 / $2,398.83	Professional		$257.04	$616.60	$2,398.83
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $125.89 / $707.95	Professional	26	$75.86	$125.89	$707.95
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $501.19 / $1,819.70	Professional	TC	$190.55	$501.19	$1,819.70
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 $269.15 / $275.42 / $295.12	Professional		$269.15	$275.42	$295.12
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $79.43 / $83.18	Professional	26	$77.62	$79.43	$83.18
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $199.53 / $213.80	Professional	TC	$190.55	$199.53	$213.80
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 $251.19 / $426.58 / $724.44	Professional		$251.19	$426.58	$724.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $79.43 / $123.03	Professional	26	$60.26	$79.43	$123.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $331.13 / $616.60	Professional	TC	$186.21	$331.13	$616.60