Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.88 / $97.72 / $169.82	Facility	26	$58.88	$97.72	$169.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $234.42 / $812.83	Professional		$138.04	$234.42	$812.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $87.10 / $208.93	Professional	26	$53.70	$87.10	$208.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $123.03 / $316.23	Professional	TC	$81.28	$123.03	$316.23
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $102.33 / $229.09	Professional		$100.00	$102.33	$229.09
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $52.48 / $81.28	Professional	26	$41.69	$52.48	$81.28
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $102.33 / $102.33	Professional	TC	$102.33	$102.33	$102.33
BCBS Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $162.18 / $309.03	Professional		$70.79	$162.18	$309.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $74.13 / $74.13 / $74.13	Facility	26	$74.13	$74.13	$74.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $213.80 / $416.87	Professional		$131.83	$213.80	$416.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $75.86 / $114.82	Professional	26	$47.86	$75.86	$114.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $134.90 / $288.40	Professional	TC	$79.43	$134.90	$288.40
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $354.81 / $1,230.27	Professional		$158.49	$354.81	$1,230.27
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $112.20 / $575.44	Professional	26	$66.07	$112.20	$575.44
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $177.83 / $707.95	Professional	TC	$93.33	$177.83	$707.95
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 $165.96 / $165.96 / $181.97	Professional		$165.96	$165.96	$181.97
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $69.18 / $72.44	Professional	26	$67.61	$69.18	$72.44
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $100.00 / $107.15	Professional	TC	$95.50	$100.00	$107.15
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 $144.54 / $229.09 / $380.19	Professional		$144.54	$229.09	$380.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $70.79 / $109.65	Professional	26	$54.95	$70.79	$109.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $144.54 / $288.40	Professional	TC	$85.11	$144.54	$288.40