Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $74.13 / $123.03 / $213.80	Facility	26	$74.13	$123.03	$213.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $478.63 / $1,621.81	Professional		$295.12	$478.63	$1,621.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $128.82 / $323.59	Professional	26	$70.79	$128.82	$323.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $338.84 / $616.60	Professional	TC	$223.87	$338.84	$616.60
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $245.47 / $263.03	Professional		$245.47	$245.47	$263.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $52.48 / $64.57	Professional	26	$52.48	$52.48	$64.57
BCBS Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $309.03 / $707.95	Professional		$87.10	$309.03	$707.95
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $89.13 / $89.13	Facility	26	$89.13	$89.13	$89.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $524.81 / $933.25	Professional		$338.84	$524.81	$933.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $97.72 / $151.36	Professional	26	$58.88	$97.72	$151.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $416.87 / $812.83	Professional	TC	$275.42	$416.87	$812.83
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $691.83 / $2,454.71	Professional		$371.54	$691.83	$2,454.71
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $138.04 / $537.03	Professional	26	$83.18	$138.04	$537.03
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $309.03 / $602.56 / $1,995.26	Professional	TC	$309.03	$602.56	$1,995.26
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 $398.11 / $407.38 / $436.52	Professional		$398.11	$407.38	$436.52
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $85.11 / $91.20	Professional	26	$83.18	$85.11	$91.20
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $309.03 / $323.59 / $354.81	Professional	TC	$309.03	$323.59	$354.81
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 $380.19 / $549.54 / $812.83	Professional		$380.19	$549.54	$812.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $87.10 / $134.90	Professional	26	$66.07	$87.10	$134.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $309.03 / $446.68 / $691.83	Professional	TC	$309.03	$446.68	$691.83