Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.66 / $159.79 / $175.18	Facility	26	$94.66	$159.79	$175.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $262.67 / $392.31 / $624.28	Professional		$262.67	$392.31	$624.28
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $82.39 / $96.23 / $240.10	Professional	26	$82.39	$96.23	$240.10
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $327.76 / $327.76 / $327.76	Professional	50	$327.76	$327.76	$327.76
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $176.33 / $309.93 / $433.15	Professional	TC	$176.33	$309.93	$433.15
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $155.51 / $311.01 / $351.59	Professional		$155.51	$311.01	$351.59
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $67.72 / $88.25 / $127.05	Professional	26	$67.72	$88.25	$127.05
BCBS Facility/Professional Professional Modifier Low / Median / High Price $112.95 / $380.05 / $728.56	Professional		$112.95	$380.05	$728.56
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $118.13 / $118.13 / $118.13	Facility	26	$118.13	$118.13	$118.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $312.87 / $483.34 / $763.53	Professional		$312.87	$483.34	$763.53
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.37 / $122.51 / $185.93	Professional	26	$74.37	$122.51	$185.93
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $458.57 / $458.57 / $523.66	Professional	50	$458.57	$458.57	$523.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $222.73 / $357.82 / $629.50	Professional	TC	$222.73	$357.82	$629.50
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $361.68 / $558.96 / $1,596.51	Professional		$361.68	$558.96	$1,596.51
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $103.39 / $153.72 / $545.44	Professional	26	$103.39	$153.72	$545.44
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $270.45 / $405.54 / $1,109.21	Professional	TC	$270.45	$405.54	$1,109.21
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 $386.78 / $395.33 / $427.44	Professional		$386.78	$395.33	$427.44
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $107.85 / $111.02 / $117.34	Professional	26	$107.85	$111.02	$117.34
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $275.76 / $287.48 / $310.12	Professional	TC	$275.76	$287.48	$310.12
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $122.75 / $371.58	Professional		$32.34	$122.75	$371.58
United Facility/Professional Professional Modifier Low / Median / High Price $354.40 / $505.26 / $758.34	Professional		$354.40	$505.26	$758.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $91.87 / $116.72 / $192.00	Professional	26	$91.87	$116.72	$192.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $262.33 / $382.13 / $615.75	Professional	TC	$262.33	$382.13	$615.75