Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.57 / $102.33 / $181.97	Facility	26	$64.57	$102.33	$181.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $354.81 / $1,202.26	Professional		$229.09	$354.81	$1,202.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $104.71 / $257.04	Professional	26	$57.54	$104.71	$257.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $239.88 / $478.63	Professional	TC	$162.18	$239.88	$478.63
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $177.83 / $380.19	Professional		$169.82	$177.83	$380.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $58.88 / $93.33	Professional	26	$44.67	$58.88	$93.33
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $208.93 / $208.93	Professional	TC	$208.93	$208.93	$208.93
BCBS Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $229.09 / $524.81	Professional		$75.86	$229.09	$524.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $77.62 / $77.62 / $77.62	Facility	26	$77.62	$77.62	$77.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $338.84 / $562.34	Professional		$208.93	$338.84	$562.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $83.18 / $123.03	Professional	26	$51.29	$83.18	$123.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $251.19 / $457.09	Professional	TC	$162.18	$251.19	$457.09
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $478.63 / $1,548.82	Professional		$263.03	$478.63	$1,548.82
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $120.23 / $501.19	Professional	26	$72.44	$120.23	$501.19
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $346.74 / $1,122.02	Professional	TC	$199.53	$346.74	$1,122.02
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 $275.42 / $281.84 / $302.00	Professional		$275.42	$281.84	$302.00
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $74.13 / $79.43	Professional	26	$72.44	$74.13	$79.43
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $208.93 / $223.87	Professional	TC	$199.53	$208.93	$223.87
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 $234.42 / $338.84 / $501.19	Professional		$234.42	$338.84	$501.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $75.86 / $114.82	Professional	26	$57.54	$75.86	$114.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $257.04 / $398.11	Professional	TC	$169.82	$257.04	$398.11