Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $59.70 / $92.54 / $110.62	Facility	26	$59.70	$92.54	$110.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $142.65 / $223.90 / $355.58	Professional		$142.65	$223.90	$355.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.28 / $61.36 / $139.00	Professional	26	$51.28	$61.36	$139.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $82.83 / $136.97 / $214.94	Professional	TC	$82.83	$136.97	$214.94
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $82.89 / $131.61 / $138.11	Professional		$82.89	$131.61	$138.11
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.22 / $49.17 / $78.52	Professional	26	$40.22	$49.17	$78.52
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $85.99 / $85.99 / $85.99	Professional	TC	$85.99	$85.99	$85.99
BCBS Facility/Professional Professional Modifier Low / Median / High Price $70.40 / $161.88 / $294.80	Professional		$70.40	$161.88	$294.80
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $73.62 / $73.62 / $73.62	Facility	26	$73.62	$73.62	$73.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $135.09 / $212.12 / $411.96	Professional		$135.09	$212.12	$411.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.52 / $75.94 / $115.86	Professional	26	$47.52	$75.94	$115.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $79.18 / $130.72 / $281.58	Professional	TC	$79.18	$130.72	$281.58
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $157.40 / $249.55 / $1,031.41	Professional		$157.40	$249.55	$1,031.41
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $67.50 / $96.14 / $475.93	Professional	26	$67.50	$96.14	$475.93
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $93.47 / $144.18 / $671.31	Professional	TC	$93.47	$144.18	$671.31
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 $164.74 / $167.58 / $180.23	Professional		$164.74	$167.58	$180.23
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $68.04 / $69.43 / $73.13	Professional	26	$68.04	$69.43	$73.13
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $95.30 / $99.54 / $107.11	Professional	TC	$95.30	$99.54	$107.11
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $74.77 / $188.55	Professional		$32.34	$74.77	$188.55
United Facility/Professional Professional Modifier Low / Median / High Price $150.44 / $239.56 / $377.89	Professional		$150.44	$239.56	$377.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.05 / $74.40 / $120.16	Professional	26	$58.05	$74.40	$120.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $89.20 / $139.18 / $259.56	Professional	TC	$89.20	$139.18	$259.56