Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $90.18 / $152.16 / $201.24	Facility	26	$90.18	$152.16	$201.24
Aetna Facility/Professional Professional Modifier Low / Median / High Price $252.89 / $373.41 / $566.98	Professional		$252.89	$373.41	$566.98
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $78.34 / $90.78 / $164.72	Professional	26	$78.34	$90.78	$164.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $170.12 / $262.88 / $393.98	Professional	TC	$170.12	$262.88	$393.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $103.20 / $103.20 / $103.20	Professional	26	$103.20	$103.20	$103.20
BCBS Facility/Professional Professional Modifier Low / Median / High Price $107.63 / $358.43 / $630.54	Professional		$107.63	$358.43	$630.54
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $113.22 / $113.22 / $113.22	Facility	26	$113.22	$113.22	$113.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $276.50 / $457.91 / $750.25	Professional		$276.50	$457.91	$750.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $71.95 / $116.10 / $176.70	Professional	26	$71.95	$116.10	$176.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $192.50 / $335.99 / $609.72	Professional	TC	$192.50	$335.99	$609.72
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $345.40 / $527.00 / $1,822.15	Professional		$345.40	$527.00	$1,822.15
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $98.26 / $146.34 / $646.36	Professional	26	$98.26	$146.34	$646.36
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $254.09 / $392.00 / $1,281.63	Professional	TC	$254.09	$392.00	$1,281.63
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 $364.77 / $372.89 / $403.00	Professional		$364.77	$372.89	$403.00
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $102.45 / $105.69 / $111.80	Professional	26	$102.45	$105.69	$111.80
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $259.08 / $270.44 / $291.20	Professional	TC	$259.08	$270.44	$291.20
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $116.96 / $365.35	Professional		$32.34	$116.96	$365.35
United Facility/Professional Professional Modifier Low / Median / High Price $324.82 / $494.11 / $744.04	Professional		$324.82	$494.11	$744.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $87.97 / $110.88 / $180.72	Professional	26	$87.97	$110.88	$180.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $227.33 / $354.03 / $578.91	Professional	TC	$227.33	$354.03	$578.91