Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.32 / $90.37 / $107.97	Facility	26	$58.32	$90.37	$107.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $226.20 / $280.64 / $494.46	Professional		$226.20	$280.64	$494.46
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.07 / $60.00 / $134.13	Professional	26	$50.07	$60.00	$134.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $170.44 / $217.46 / $341.67	Professional	TC	$170.44	$217.46	$341.67
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $170.36 / $218.28 / $232.65	Professional		$170.36	$218.28	$232.65
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $39.56 / $51.80 / $74.18	Professional	26	$39.56	$51.80	$74.18
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $240.82 / $240.82 / $240.82	Professional	TC	$240.82	$240.82	$240.82
BCBS Facility/Professional Professional Modifier Low / Median / High Price $68.76 / $228.71 / $467.23	Professional		$68.76	$228.71	$467.23
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $72.00 / $72.00 / $72.00	Facility	26	$72.00	$72.00	$72.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $218.31 / $344.97 / $520.40	Professional		$218.31	$344.97	$520.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.39 / $75.00 / $113.31	Professional	26	$46.39	$75.00	$113.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $163.56 / $262.55 / $396.62	Professional	TC	$163.56	$262.55	$396.62
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $259.64 / $393.95 / $1,190.75	Professional		$259.64	$393.95	$1,190.75
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $65.94 / $93.87 / $362.83	Professional	26	$65.94	$93.87	$362.83
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $198.61 / $310.44 / $858.98	Professional	TC	$198.61	$310.44	$858.98
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 $270.27 / $277.93 / $298.97	Professional		$270.27	$277.93	$298.97
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $66.38 / $67.80 / $71.44	Professional	26	$66.38	$67.80	$71.44
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $202.50 / $211.55 / $227.54	Professional	TC	$202.50	$211.55	$227.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $74.73 / $312.77	Professional		$32.34	$74.73	$312.77
United Facility/Professional Professional Modifier Low / Median / High Price $243.16 / $327.66 / $498.76	Professional		$243.16	$327.66	$498.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.29 / $77.23 / $147.44	Professional	26	$58.29	$77.23	$147.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $174.75 / $249.90 / $415.52	Professional	TC	$174.75	$249.90	$415.52