Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $151.36 / $263.03	Facility	26	$89.13	$151.36	$263.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $457.09 / $1,047.13	Professional		$281.84	$457.09	$1,047.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $141.25 / $389.05	Professional	26	$85.11	$141.25	$389.05
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $302.00 / $575.44	Professional	TC	$194.98	$302.00	$575.44
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $213.80 / $213.80	Professional		$213.80	$213.80	$213.80
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $79.43 / $81.28	Professional	26	$79.43	$79.43	$81.28
BCBS Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $323.59 / $575.44	Professional		$107.15	$323.59	$575.44
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $117.49 / $117.49 / $117.49	Facility	26	$117.49	$117.49	$117.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $478.63 / $912.01	Professional		$281.84	$478.63	$912.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $123.03 / $181.97	Professional	26	$74.13	$123.03	$181.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $331.13 / $741.31	Professional	TC	$190.55	$331.13	$741.31
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $758.58 / $2,884.03	Professional		$309.03	$758.58	$2,884.03
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $173.78 / $933.25	Professional	26	$102.33	$173.78	$933.25
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $602.56 / $2,089.30	Professional	TC	$218.78	$602.56	$2,089.30
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 $331.13 / $338.84 / $363.08	Professional		$331.13	$338.84	$363.08
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $107.15 / $112.20	Professional	26	$102.33	$107.15	$112.20
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $234.42 / $251.19	Professional	TC	$223.87	$234.42	$251.19
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 $302.00 / $512.86 / $870.96	Professional		$302.00	$512.86	$870.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $109.65 / $169.82	Professional	26	$83.18	$109.65	$169.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $363.08 / $724.44	Professional	TC	$213.80	$363.08	$724.44