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 / $426.58	Facility	26	$89.13	$151.36	$426.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $457.09 / $1,096.48	Professional		$275.42	$457.09	$1,096.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $141.25 / $416.87	Professional	26	$85.11	$141.25	$416.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $302.00 / $588.84	Professional	TC	$190.55	$302.00	$588.84
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $63.10 / $79.43	Professional	26	$63.10	$63.10	$79.43
BCBS Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $269.15 / $562.34	Professional		$107.15	$269.15	$562.34
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $109.65 / $109.65 / $109.65	Facility	26	$109.65	$109.65	$109.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $478.63 / $912.01	Professional		$275.42	$478.63	$912.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $120.23 / $177.83	Professional	26	$72.44	$120.23	$177.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $331.13 / $741.31	Professional	TC	$186.21	$331.13	$741.31
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $741.31 / $2,884.03	Professional		$309.03	$741.31	$2,884.03
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $169.82 / $954.99	Professional	26	$102.33	$169.82	$954.99
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $602.56 / $2,089.30	Professional	TC	$213.80	$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 $323.59 / $331.13 / $354.81	Professional		$323.59	$331.13	$354.81
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $104.71 / $112.20	Professional	26	$102.33	$104.71	$112.20
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $229.09 / $245.47	Professional	TC	$218.78	$229.09	$245.47
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 / $501.19 / $870.96	Professional		$302.00	$501.19	$870.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $107.15 / $165.96	Professional	26	$81.28	$107.15	$165.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $354.81 / $707.95	Professional	TC	$208.93	$354.81	$707.95