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 $160.63 / $274.70 / $436.64	Professional		$160.63	$274.70	$436.64
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.07 / $63.18 / $161.16	Professional	26	$50.07	$63.18	$161.16
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $117.33 / $198.79 / $307.75	Professional	TC	$117.33	$198.79	$307.75
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $113.47 / $126.08 / $160.56	Professional		$113.47	$126.08	$160.56
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.21 / $57.70 / $72.20	Professional	26	$40.21	$57.70	$72.20
BCBS Facility/Professional Professional Modifier Low / Median / High Price $68.76 / $196.63 / $376.94	Professional		$68.76	$196.63	$376.94
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 $170.86 / $269.83 / $466.72	Professional		$170.86	$269.83	$466.72
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 $112.98 / $186.59 / $350.70	Professional	TC	$112.98	$186.59	$350.70
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $191.43 / $304.95 / $1,014.41	Professional		$191.43	$304.95	$1,014.41
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $65.94 / $93.87 / $372.94	Professional	26	$65.94	$93.87	$372.94
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $129.77 / $200.32 / $712.94	Professional	TC	$129.77	$200.32	$712.94
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 $200.11 / $204.28 / $220.25	Professional		$200.11	$204.28	$220.25
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 $132.31 / $137.90 / $148.81	Professional	TC	$132.31	$137.90	$148.81
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $74.73 / $230.41	Professional		$32.34	$74.73	$230.41
United Facility/Professional Professional Modifier Low / Median / High Price $196.69 / $296.24 / $448.37	Professional		$196.69	$296.24	$448.37
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.50 / $69.89 / $120.40	Professional	26	$56.50	$69.89	$120.40
United Facility/Professional Professional Modifier TC Low / Median / High Price $136.99 / $221.34 / $336.27	Professional	TC	$136.99	$221.34	$336.27