Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.45 / $115.90 / $116.95	Facility	26	$62.45	$115.90	$116.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $196.69 / $325.00 / $427.97	Professional		$196.69	$325.00	$427.97
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.87 / $65.90 / $143.63	Professional	26	$58.87	$65.90	$143.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $137.84 / $240.00 / $358.73	Professional	TC	$137.84	$240.00	$358.73
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $118.14 / $160.63 / $178.50	Professional		$118.14	$160.63	$178.50
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $43.46 / $50.13 / $80.34	Professional	26	$43.46	$50.13	$80.34
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $109.48 / $109.48 / $109.48	Professional	TC	$109.48	$109.48	$109.48
BCBS Facility/Professional Professional Modifier Low / Median / High Price $74.48 / $231.07 / $442.95	Professional		$74.48	$231.07	$442.95
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $84.57 / $84.57 / $84.57	Facility	26	$84.57	$84.57	$84.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $200.78 / $319.19 / $610.48	Professional		$200.78	$319.19	$610.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.33 / $83.33 / $130.50	Professional	26	$51.33	$83.33	$130.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $138.19 / $228.13 / $478.44	Professional	TC	$138.19	$228.13	$478.44
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $225.09 / $349.09 / $1,528.25	Professional		$225.09	$349.09	$1,528.25
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $71.42 / $101.50 / $553.39	Professional	26	$71.42	$101.50	$553.39
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $158.74 / $249.00 / $1,125.60	Professional	TC	$158.74	$249.00	$1,125.60
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 $235.16 / $240.40 / $259.32	Professional		$235.16	$240.40	$259.32
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $71.51 / $73.31 / $77.38	Professional	26	$71.51	$73.31	$77.38
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $161.85 / $168.90 / $181.94	Professional	TC	$161.85	$168.90	$181.94
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $80.95 / $271.29	Professional		$32.34	$80.95	$271.29
United Facility/Professional Professional Modifier Low / Median / High Price $233.25 / $377.07 / $585.01	Professional		$233.25	$377.07	$585.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.84 / $84.51 / $133.13	Professional	26	$66.84	$84.51	$133.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $164.23 / $270.19 / $453.01	Professional	TC	$164.23	$270.19	$453.01