Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.93 / $105.41 / $159.65	Facility	26	$67.93	$105.41	$159.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $221.49 / $472.35 / $1,121.24	Professional		$221.49	$472.35	$1,121.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.93 / $125.67 / $394.25	Professional	26	$67.93	$125.67	$394.25
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $228.24 / $712.50 / $911.91	Professional	50	$228.24	$712.50	$911.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $178.80 / $305.00 / $472.35	Professional	TC	$178.80	$305.00	$472.35
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $151.08 / $185.77 / $291.14	Professional		$151.08	$185.77	$291.14
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $46.85 / $60.78 / $86.54	Professional	26	$46.85	$60.78	$86.54
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $191.89 / $191.89 / $191.89	Professional	TC	$191.89	$191.89	$191.89
BCBS Facility/Professional Professional Modifier Low / Median / High Price $80.22 / $261.58 / $501.44	Professional		$80.22	$261.58	$501.44
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $83.32 / $83.32 / $83.32	Facility	26	$83.32	$83.32	$83.32
Cigna Facility/Professional Professional Modifier Low / Median / High Price $227.30 / $395.21 / $733.71	Professional		$227.30	$395.21	$733.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.85 / $89.12 / $135.21	Professional	26	$53.85	$89.12	$135.21
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $338.09 / $338.09 / $386.61	Professional	50	$338.09	$338.09	$386.61
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $159.80 / $287.99 / $610.28	Professional	TC	$159.80	$287.99	$610.28
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $255.23 / $395.33 / $1,892.77	Professional		$255.23	$395.33	$1,892.77
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $76.92 / $109.44 / $424.47	Professional	26	$76.92	$109.44	$424.47
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $183.56 / $287.94 / $1,486.69	Professional	TC	$183.56	$287.94	$1,486.69
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 $266.20 / $272.77 / $293.67	Professional		$266.20	$272.77	$293.67
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $77.31 / $79.04 / $83.33	Professional	26	$77.31	$79.04	$83.33
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $187.16 / $195.46 / $210.33	Professional	TC	$187.16	$195.46	$210.33
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $87.18 / $307.22	Professional		$32.34	$87.18	$307.22
United Facility/Professional Professional Modifier Low / Median / High Price $259.23 / $433.64 / $719.34	Professional		$259.23	$433.64	$719.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $65.37 / $83.76 / $137.86	Professional	26	$65.37	$83.76	$137.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $190.81 / $325.08 / $582.04	Professional	TC	$190.81	$325.08	$582.04