Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $107.15 / $177.83 / $309.03	Facility	26	$107.15	$177.83	$309.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $575.44 / $2,754.23	Professional		$354.81	$575.44	$2,754.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $181.97 / $537.03	Professional	26	$100.00	$181.97	$537.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $363.08 / $891.25	Professional	TC	$245.47	$363.08	$891.25
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $263.03 / $295.12	Professional		$251.19	$263.03	$295.12
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $95.50 / $141.25	Professional	26	$75.86	$95.50	$141.25
BCBS Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $363.08 / $724.44	Professional		$128.82	$363.08	$724.44
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $131.83 / $131.83 / $131.83	Facility	26	$131.83	$131.83	$131.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $562.34 / $1,318.26	Professional		$346.74	$562.34	$1,318.26
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $144.54 / $213.80	Professional	26	$87.10	$144.54	$213.80
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $407.38 / $1,122.02	Professional	TC	$239.88	$407.38	$1,122.02
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $1,023.29 / $3,981.07	Professional		$371.54	$1,023.29	$3,981.07
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $199.53 / $1,258.93	Professional	26	$123.03	$199.53	$1,258.93
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $676.08 / $3,090.30	Professional	TC	$275.42	$676.08	$3,090.30
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 $407.38 / $416.87 / $446.68	Professional		$407.38	$416.87	$446.68
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $125.89 / $134.90	Professional	26	$123.03	$125.89	$134.90
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $295.12 / $316.23	Professional	TC	$281.84	$295.12	$316.23
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 $371.54 / $645.65 / $1,258.93	Professional		$371.54	$645.65	$1,258.93
United Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $125.89 / $199.53	Professional	26	$97.72	$125.89	$199.53
United Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $467.74 / $1,047.13	Professional	TC	$269.15	$467.74	$1,047.13