Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.14 / $99.46 / $118.50	Facility	26	$64.14	$99.46	$118.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $231.68 / $303.77 / $556.59	Professional		$231.68	$303.77	$556.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.86 / $74.53 / $252.52	Professional	26	$54.86	$74.53	$252.52
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $170.44 / $248.90 / $365.90	Professional	TC	$170.44	$248.90	$365.90
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $151.77 / $173.82 / $274.86	Professional		$151.77	$173.82	$274.86
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $44.59 / $59.21 / $81.69	Professional	26	$44.59	$59.21	$81.69
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $181.35 / $210.18 / $210.18	Professional	TC	$181.35	$210.18	$210.18
BCBS Facility/Professional Professional Modifier Low / Median / High Price $75.72 / $270.70 / $518.95	Professional		$75.72	$270.70	$518.95
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $78.48 / $78.48 / $78.48	Facility	26	$78.48	$78.48	$78.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $226.03 / $351.32 / $534.83	Professional		$226.03	$351.32	$534.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.74 / $81.68 / $123.53	Professional	26	$50.74	$81.68	$123.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $162.32 / $260.56 / $411.93	Professional	TC	$162.32	$260.56	$411.93
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $264.29 / $402.65 / $1,304.26	Professional		$264.29	$402.65	$1,304.26
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $72.61 / $103.19 / $407.87	Professional	26	$72.61	$103.19	$407.87
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $197.10 / $303.99 / $908.31	Professional	TC	$197.10	$303.99	$908.31
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 $275.50 / $282.69 / $304.47	Professional		$275.50	$282.69	$304.47
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $72.75 / $74.53 / $78.66	Professional	26	$72.75	$74.53	$78.66
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $200.97 / $209.94 / $225.82	Professional	TC	$200.97	$209.94	$225.82
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $82.29 / $318.52	Professional		$32.34	$82.29	$318.52
United Facility/Professional Professional Modifier Low / Median / High Price $239.00 / $340.30 / $511.39	Professional		$239.00	$340.30	$511.39
United Facility/Professional Professional Modifier 26 Low / Median / High Price $63.58 / $86.85 / $157.66	Professional	26	$63.58	$86.85	$157.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $183.75 / $267.87 / $428.88	Professional	TC	$183.75	$267.87	$428.88