Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.43 / $77.48 / $141.30	Facility	26	$49.43	$77.48	$141.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $136.22 / $221.75 / $353.78	Professional		$136.22	$221.75	$353.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.14 / $56.39 / $159.75	Professional	26	$44.14	$56.39	$159.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $86.77 / $160.31 / $231.46	Professional	TC	$86.77	$160.31	$231.46
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $78.65 / $98.32 / $125.19	Professional		$78.65	$98.32	$125.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $33.90 / $39.77 / $63.59	Professional	26	$33.90	$39.77	$63.59
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $88.42 / $88.42 / $88.42	Professional	TC	$88.42	$88.42	$88.42
BCBS Facility/Professional Professional Modifier Low / Median / High Price $58.94 / $153.46 / $269.95	Professional		$58.94	$153.46	$269.95
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.76 / $62.76 / $62.76	Facility	26	$62.76	$62.76	$62.76
Cigna Facility/Professional Professional Modifier Low / Median / High Price $133.34 / $214.83 / $428.06	Professional		$133.34	$214.83	$428.06
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.64 / $65.94 / $99.64	Professional	26	$39.64	$65.94	$99.64
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $83.67 / $144.69 / $320.62	Professional	TC	$83.67	$144.69	$320.62
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $149.53 / $237.24 / $1,061.81	Professional		$149.53	$237.24	$1,061.81
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $56.52 / $82.43 / $370.13	Professional	26	$56.52	$82.43	$370.13
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $96.11 / $148.22 / $803.25	Professional	TC	$96.11	$148.22	$803.25
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 $156.16 / $159.44 / $171.34	Professional		$156.16	$159.44	$171.34
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $57.10 / $58.18 / $61.23	Professional	26	$57.10	$58.18	$61.23
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $97.99 / $102.35 / $110.11	Professional	TC	$97.99	$102.35	$110.11
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $64.06 / $179.25	Professional		$32.34	$64.06	$179.25
United Facility/Professional Professional Modifier Low / Median / High Price $156.49 / $252.04 / $393.74	Professional		$156.49	$252.04	$393.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.48 / $63.91 / $102.50	Professional	26	$50.48	$63.91	$102.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $105.74 / $183.51 / $280.30	Professional	TC	$105.74	$183.51	$280.30