Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $91.56 / $138.19 / $169.20	Facility	26	$91.56	$138.19	$169.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $259.50 / $392.89 / $709.74	Professional		$259.50	$392.89	$709.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $82.98 / $111.00 / $375.25	Professional	26	$82.98	$111.00	$375.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $170.48 / $292.36 / $403.94	Professional	TC	$170.48	$292.36	$403.94
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $198.35 / $250.14 / $316.85	Professional		$198.35	$250.14	$316.85
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $62.17 / $80.26 / $117.88	Professional	26	$62.17	$80.26	$117.88
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $156.34 / $221.27 / $221.27	Professional	TC	$156.34	$221.27	$221.27
BCBS Facility/Professional Professional Modifier Low / Median / High Price $109.28 / $332.84 / $638.04	Professional		$109.28	$332.84	$638.04
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $118.93 / $118.93 / $118.93	Facility	26	$118.93	$118.93	$118.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $275.00 / $435.00 / $767.15	Professional		$275.00	$435.00	$767.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $73.06 / $117.88 / $180.14	Professional	26	$73.06	$117.88	$180.14
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $192.50 / $306.23 / $590.69	Professional	TC	$192.50	$306.23	$590.69
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $321.11 / $496.37 / $2,131.42	Professional		$321.11	$496.37	$2,131.42
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $99.78 / $148.44 / $585.44	Professional	26	$99.78	$148.44	$585.44
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $221.19 / $340.29 / $1,545.99	Professional	TC	$221.19	$340.29	$1,545.99
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 $338.73 / $345.55 / $373.74	Professional		$338.73	$345.55	$373.74
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $104.08 / $107.26 / $113.52	Professional	26	$104.08	$107.26	$113.52
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $231.47 / $241.48 / $260.22	Professional	TC	$231.47	$241.48	$260.22
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $115.51 / $368.03	Professional		$32.34	$115.51	$368.03
United Facility/Professional Professional Modifier Low / Median / High Price $305.23 / $469.14 / $755.70	Professional		$305.23	$469.14	$755.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $92.65 / $118.05 / $183.42	Professional	26	$92.65	$118.05	$183.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $212.54 / $348.03 / $545.04	Professional	TC	$212.54	$348.03	$545.04