Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $107.72 / $169.75 / $253.30	Facility	26	$107.72	$169.75	$253.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $361.52 / $475.00 / $1,320.50	Professional		$361.52	$475.00	$1,320.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $107.72 / $148.22 / $513.24	Professional	26	$107.72	$148.22	$513.24
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $254.43 / $335.00 / $557.76	Professional	TC	$254.43	$335.00	$557.76
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $204.94 / $308.14 / $443.62	Professional		$204.94	$308.14	$443.62
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $86.81 / $124.01 / $145.19	Professional	26	$86.81	$124.01	$145.19
BCBS Facility/Professional Professional Modifier Low / Median / High Price $129.33 / $399.24 / $765.35	Professional		$129.33	$399.24	$765.35
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $131.86 / $131.86 / $131.86	Facility	26	$131.86	$131.86	$131.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $346.92 / $540.00 / $1,273.39	Professional		$346.92	$540.00	$1,273.39
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.33 / $139.52 / $210.89	Professional	26	$85.33	$139.52	$210.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $238.56 / $390.00 / $1,093.77	Professional	TC	$238.56	$390.00	$1,093.77
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $379.37 / $603.54 / $3,689.17	Professional		$379.37	$603.54	$3,689.17
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $123.07 / $175.72 / $1,101.58	Professional	26	$123.07	$175.72	$1,101.58
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $274.02 / $429.84 / $2,936.44	Professional	TC	$274.02	$429.84	$2,936.44
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 $406.30 / $414.84 / $448.34	Professional		$406.30	$414.84	$448.34
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $123.07 / $126.91 / $134.34	Professional	26	$123.07	$126.91	$134.34
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $279.39 / $291.77 / $313.99	Professional	TC	$279.39	$291.77	$313.99
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $140.54 / $469.04	Professional		$32.34	$140.54	$469.04
United Facility/Professional Professional Modifier Low / Median / High Price $393.76 / $662.16 / $1,147.07	Professional		$393.76	$662.16	$1,147.07
United Facility/Professional Professional Modifier 26 Low / Median / High Price $104.20 / $131.22 / $208.09	Professional	26	$104.20	$131.22	$208.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $286.19 / $478.63 / $915.85	Professional	TC	$286.19	$478.63	$915.85