Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $81.28 / $169.82	Facility	26	$57.54	$81.28	$169.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $288.40 / $1,047.13	Professional		$134.90	$288.40	$1,047.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $70.79 / $234.42	Professional	26	$50.12	$70.79	$234.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $165.96 / $436.52	Professional	TC	$70.79	$165.96	$436.52
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $123.03 / $154.88	Professional		$61.66	$123.03	$154.88
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $52.48 / $79.43	Professional	26	$41.69	$52.48	$79.43
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $74.13 / $165.96	Professional	TC	$51.29	$74.13	$165.96
BCBS Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $194.98 / $380.19	Professional		$69.18	$194.98	$380.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $77.62 / $77.62 / $77.62	Facility	26	$77.62	$77.62	$77.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $275.42 / $501.19	Professional		$169.82	$275.42	$501.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $77.62 / $114.82	Professional	26	$47.86	$77.62	$114.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $190.55 / $389.05	Professional	TC	$112.20	$190.55	$389.05
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $446.68 / $1,995.26	Professional		$194.98	$446.68	$1,995.26
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $112.20 / $501.19	Professional	26	$66.07	$112.20	$501.19
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $323.59 / $1,621.81	Professional	TC	$131.83	$323.59	$1,621.81
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 $199.53 / $204.17 / $218.78	Professional		$199.53	$204.17	$218.78
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $67.61 / $72.44	Professional	26	$66.07	$67.61	$72.44
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $138.04 / $147.91	Professional	TC	$131.83	$138.04	$147.91
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 $190.55 / $295.12 / $478.63	Professional		$190.55	$295.12	$478.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $74.13 / $112.20	Professional	26	$54.95	$74.13	$112.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $218.78 / $380.19	Professional	TC	$125.89	$218.78	$380.19