Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $95.50 / $169.82	Facility	26	$57.54	$95.50	$169.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $309.03 / $954.99	Professional		$218.78	$309.03	$954.99
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $91.20 / $208.93	Professional	26	$52.48	$91.20	$208.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $218.78 / $436.52	Professional	TC	$162.18	$218.78	$436.52
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $51.29 / $79.43	Professional	26	$40.74	$51.29	$79.43
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $218.78 / $218.78	Professional	TC	$218.78	$218.78	$218.78
BCBS Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $223.87 / $467.74	Professional		$69.18	$223.87	$467.74
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $72.44 / $72.44 / $72.44	Facility	26	$72.44	$72.44	$72.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $331.13 / $524.81	Professional		$204.17	$331.13	$524.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $75.86 / $112.20	Professional	26	$46.77	$75.86	$112.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $251.19 / $407.38	Professional	TC	$162.18	$251.19	$407.38
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $467.74 / $1,445.44	Professional		$257.04	$467.74	$1,445.44
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $109.65 / $407.38	Professional	26	$64.57	$109.65	$407.38
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $346.74 / $1,148.15	Professional	TC	$199.53	$346.74	$1,148.15
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 $269.15 / $275.42 / $302.00	Professional		$269.15	$275.42	$302.00
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $67.61 / $70.79	Professional	26	$66.07	$67.61	$70.79
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $213.80 / $229.09	Professional	TC	$204.17	$213.80	$229.09
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 $229.09 / $316.23 / $478.63	Professional		$229.09	$316.23	$478.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $69.18 / $107.15	Professional	26	$52.48	$69.18	$107.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $239.88 / $389.05	Professional	TC	$169.82	$239.88	$389.05