Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.67 / $88.60 / $108.62	Facility	26	$58.67	$88.60	$108.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $160.69 / $282.66 / $760.12	Professional		$160.69	$282.66	$760.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.44 / $76.27 / $284.00	Professional	26	$52.44	$76.27	$284.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $117.00 / $198.79 / $305.77	Professional	TC	$117.00	$198.79	$305.77
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $80.44 / $126.32 / $199.47	Professional		$80.44	$126.32	$199.47
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $39.51 / $52.09 / $74.63	Professional	26	$39.51	$52.09	$74.63
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $59.63 / $69.06 / $89.49	Professional	TC	$59.63	$69.06	$89.49
BCBS Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $197.01 / $377.66	Professional		$69.18	$197.01	$377.66
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $76.87 / $76.87 / $76.87	Facility	26	$76.87	$76.87	$76.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $171.19 / $270.14 / $500.20	Professional		$171.19	$270.14	$500.20
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.02 / $76.92 / $116.71	Professional	26	$47.02	$76.92	$116.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $112.98 / $186.59 / $382.63	Professional	TC	$112.98	$186.59	$382.63
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $191.80 / $305.55 / $1,315.18	Professional		$191.80	$305.55	$1,315.18
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $66.34 / $94.39 / $332.82	Professional	26	$66.34	$94.39	$332.82
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $129.77 / $203.56 / $913.77	Professional	TC	$129.77	$203.56	$913.77
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 $200.49 / $204.69 / $220.68	Professional		$200.49	$204.69	$220.68
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $66.78 / $68.17 / $71.86	Professional	26	$66.78	$68.17	$71.86
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $132.31 / $137.90 / $148.81	Professional	TC	$132.31	$137.90	$148.81
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $75.18 / $230.86	Professional		$32.34	$75.18	$230.86
United Facility/Professional Professional Modifier Low / Median / High Price $197.42 / $309.56 / $490.23	Professional		$197.42	$309.56	$490.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $59.97 / $75.45 / $125.76	Professional	26	$59.97	$75.45	$125.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $133.87 / $221.39 / $350.08	Professional	TC	$133.87	$221.39	$350.08