Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $90.56 / $151.29 / $212.25	Facility	26	$90.56	$151.29	$212.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $289.48 / $413.68 / $547.09	Professional		$289.48	$413.68	$547.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.56 / $124.20 / $168.38	Professional	26	$89.56	$124.20	$168.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $203.68 / $289.48 / $384.67	Professional	TC	$203.68	$289.48	$384.67
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $166.70 / $166.70 / $230.63	Professional		$166.70	$166.70	$230.63
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $84.36 / $110.95 / $110.95	Professional	26	$84.36	$110.95	$110.95
BCBS Facility/Professional Professional Modifier Low / Median / High Price $108.06 / $324.77 / $571.36	Professional		$108.06	$324.77	$571.36
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $118.52 / $118.52 / $118.52	Facility	26	$118.52	$118.52	$118.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $276.77 / $440.14 / $915.68	Professional		$276.77	$440.14	$915.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.81 / $116.57 / $180.80	Professional	26	$70.81	$116.57	$180.80
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $191.23 / $309.86 / $726.86	Professional	TC	$191.23	$309.86	$726.86
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $315.70 / $490.98 / $2,370.12	Professional		$315.70	$490.98	$2,370.12
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $102.80 / $146.80 / $841.00	Professional	26	$102.80	$146.80	$841.00
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $220.24 / $345.48 / $1,891.84	Professional	TC	$220.24	$345.48	$1,891.84
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 $330.53 / $337.03 / $364.73	Professional		$330.53	$337.03	$364.73
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $102.80 / $105.96 / $112.26	Professional	26	$102.80	$105.96	$112.26
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $224.56 / $234.22 / $252.47	Professional	TC	$224.56	$234.22	$252.47
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $117.44 / $381.56	Professional		$32.34	$117.44	$381.56
United Facility/Professional Professional Modifier Low / Median / High Price $318.94 / $505.93 / $852.87	Professional		$318.94	$505.93	$852.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $90.27 / $115.33 / $172.14	Professional	26	$90.27	$115.33	$172.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $226.43 / $381.56 / $646.04	Professional	TC	$226.43	$381.56	$646.04