Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $113.89 / $190.61 / $267.47	Facility	26	$113.89	$190.61	$267.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $443.89 / $545.57 / $1,088.77	Professional		$443.89	$545.57	$1,088.77
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $112.50 / $140.00 / $250.49	Professional	26	$112.50	$140.00	$250.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $333.62 / $382.10 / $701.08	Professional	TC	$333.62	$382.10	$701.08
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $352.94 / $451.21 / $556.39	Professional		$352.94	$451.21	$556.39
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $81.43 / $101.90 / $177.31	Professional	26	$81.43	$101.90	$177.31
BCBS Facility/Professional Professional Modifier Low / Median / High Price $136.29 / $472.97 / $1,052.93	Professional		$136.29	$472.97	$1,052.93
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $139.18 / $139.18 / $139.18	Facility	26	$139.18	$139.18	$139.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $476.50 / $734.05 / $1,463.90	Professional		$476.50	$734.05	$1,463.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $90.05 / $149.01 / $222.58	Professional	26	$90.05	$149.01	$222.58
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $363.16 / $573.45 / $1,231.40	Professional	TC	$363.16	$573.45	$1,231.40
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $524.15 / $833.88 / $3,378.85	Professional		$524.15	$833.88	$3,378.85
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $129.44 / $185.06 / $855.41	Professional	26	$129.44	$185.06	$855.41
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $417.14 / $654.34 / $2,697.66	Professional	TC	$417.14	$654.34	$2,697.66
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 $558.97 / $573.87 / $619.45	Professional		$558.97	$573.87	$619.45
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $129.44 / $133.65 / $141.57	Professional	26	$129.44	$133.65	$141.57
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $425.32 / $444.43 / $477.88	Professional	TC	$425.32	$444.43	$477.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $148.10 / $646.69	Professional		$32.34	$148.10	$646.69
United Facility/Professional Professional Modifier Low / Median / High Price $556.21 / $856.90 / $1,379.36	Professional		$556.21	$856.90	$1,379.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $109.94 / $135.85 / $214.17	Professional	26	$109.94	$135.85	$214.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $442.61 / $738.71 / $1,111.70	Professional	TC	$442.61	$738.71	$1,111.70