Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $90.19 / $150.28 / $201.26	Facility	26	$90.19	$150.28	$201.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $358.84 / $475.00 / $727.09	Professional		$358.84	$475.00	$727.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.29 / $128.78 / $199.08	Professional	26	$89.29	$128.78	$199.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $262.50 / $335.00 / $509.42	Professional	TC	$262.50	$335.00	$509.42
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $64.40 / $64.40 / $64.40	Professional	26	$64.40	$64.40	$64.40
BCBS Facility/Professional Professional Modifier Low / Median / High Price $107.63 / $384.63 / $699.11	Professional		$107.63	$384.63	$699.11
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $110.84 / $110.84 / $110.84	Facility	26	$110.84	$110.84	$110.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $342.21 / $531.39 / $894.63	Professional		$342.21	$531.39	$894.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.62 / $116.11 / $175.60	Professional	26	$70.62	$116.11	$175.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $252.80 / $402.09 / $714.07	Professional	TC	$252.80	$402.09	$714.07
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $378.85 / $602.72 / $2,430.80	Professional		$378.85	$602.72	$2,430.80
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $102.44 / $146.30 / $708.84	Professional	26	$102.44	$146.30	$708.84
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $293.02 / $459.64 / $1,894.59	Professional	TC	$293.02	$459.64	$1,894.59
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 $404.43 / $414.06 / $447.73	Professional		$404.43	$414.06	$447.73
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $102.44 / $105.66 / $111.81	Professional	26	$102.44	$105.66	$111.81
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $298.77 / $311.64 / $335.92	Professional	TC	$298.77	$311.64	$335.92
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $116.97 / $468.40	Professional		$32.34	$116.97	$468.40
United Facility/Professional Professional Modifier Low / Median / High Price $389.56 / $562.24 / $837.47	Professional		$389.56	$562.24	$837.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $87.66 / $110.47 / $173.76	Professional	26	$87.66	$110.47	$173.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $297.98 / $448.76 / $666.54	Professional	TC	$297.98	$448.76	$666.54