Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $125.89 / $263.03	Facility	26	$91.20	$125.89	$263.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $436.52 / $1,659.59	Professional		$257.04	$436.52	$1,659.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $95.50 / $338.84	Professional	26	$79.43	$95.50	$338.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $245.47 / $562.34	Professional	TC	$162.18	$245.47	$562.34
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $204.17 / $426.58	Professional		$186.21	$204.17	$426.58
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $79.43 / $134.90	Professional	26	$64.57	$79.43	$134.90
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $190.55 / $257.04	Professional	TC	$134.90	$190.55	$257.04
BCBS Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $281.84 / $630.96	Professional		$109.65	$281.84	$630.96
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $120.23 / $120.23 / $120.23	Facility	26	$120.23	$120.23	$120.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $426.58 / $794.33	Professional		$275.42	$426.58	$794.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $117.49 / $177.83	Professional	26	$74.13	$117.49	$177.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $302.00 / $602.56	Professional	TC	$190.55	$302.00	$602.56
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $645.65 / $2,187.76	Professional		$323.59	$645.65	$2,187.76
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $173.78 / $616.60	Professional	26	$100.00	$173.78	$616.60
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $416.87 / $1,621.81	Professional	TC	$218.78	$416.87	$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 $338.84 / $346.74 / $371.54	Professional		$338.84	$346.74	$371.54
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $107.15 / $114.82	Professional	26	$104.71	$107.15	$114.82
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $239.88 / $263.03	Professional	TC	$229.09	$239.88	$263.03
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 $295.12 / $457.09 / $758.58	Professional		$295.12	$457.09	$758.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $109.65 / $165.96	Professional	26	$83.18	$109.65	$165.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $331.13 / $602.56	Professional	TC	$199.53	$331.13	$602.56