Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.07 / $103.29 / $113.25	Facility	26	$61.07	$103.29	$113.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $171.00 / $282.06 / $424.18	Professional		$171.00	$282.06	$424.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.46 / $61.58 / $154.79	Professional	26	$52.46	$61.58	$154.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $113.79 / $214.72 / $307.75	Professional	TC	$113.79	$214.72	$307.75
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $221.11 / $221.11 / $221.11	Professional		$221.11	$221.11	$221.11
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $42.70 / $76.13 / $84.59	Professional	26	$42.70	$76.13	$84.59
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $59.28 / $59.28 / $59.28	Professional	TC	$59.28	$59.28	$59.28
BCBS Facility/Professional Professional Modifier Low / Median / High Price $72.04 / $199.11 / $350.27	Professional		$72.04	$199.11	$350.27
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.23 / $75.23 / $75.23	Facility	26	$75.23	$75.23	$75.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $173.02 / $279.33 / $509.31	Professional		$173.02	$279.33	$509.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.25 / $78.06 / $120.16	Professional	26	$48.25	$78.06	$120.16
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $112.32 / $188.09 / $394.27	Professional	TC	$112.32	$188.09	$394.27
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $193.85 / $308.48 / $1,484.64	Professional		$193.85	$308.48	$1,484.64
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $69.06 / $98.42 / $542.97	Professional	26	$69.06	$98.42	$542.97
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $129.02 / $202.38 / $974.50	Professional	TC	$129.02	$202.38	$974.50
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 $202.63 / $206.80 / $222.79	Professional		$202.63	$206.80	$222.79
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $69.70 / $71.08 / $74.83	Professional	26	$69.70	$71.08	$74.83
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $131.55 / $137.10 / $147.94	Professional	TC	$131.55	$137.10	$147.94
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $78.28 / $233.08	Professional		$32.34	$78.28	$233.08
United Facility/Professional Professional Modifier Low / Median / High Price $196.73 / $307.72 / $491.95	Professional		$196.73	$307.72	$491.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $59.32 / $75.81 / $117.15	Professional	26	$59.32	$75.81	$117.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $134.59 / $226.36 / $338.04	Professional	TC	$134.59	$226.36	$338.04