Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.98 / $108.67 / $129.72	Facility	26	$69.98	$108.67	$129.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $234.79 / $366.58 / $874.69	Professional		$234.79	$366.58	$874.69
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.39 / $81.81 / $161.12	Professional	26	$60.39	$81.81	$161.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $170.44 / $292.22 / $397.96	Professional	TC	$170.44	$292.22	$397.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $181.56 / $210.35 / $240.59	Professional		$181.56	$210.35	$240.59
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $49.91 / $62.71 / $88.52	Professional	26	$49.91	$62.71	$88.52
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $205.63 / $221.06 / $221.06	Professional	TC	$205.63	$221.06	$221.06
BCBS Facility/Professional Professional Modifier Low / Median / High Price $82.68 / $261.75 / $582.70	Professional		$82.68	$261.75	$582.70
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $86.57 / $86.57 / $86.57	Facility	26	$86.57	$86.57	$86.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $254.09 / $395.04 / $654.16	Professional		$254.09	$395.04	$654.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.89 / $90.00 / $136.50	Professional	26	$55.89	$90.00	$136.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $184.00 / $297.07 / $531.46	Professional	TC	$184.00	$297.07	$531.46
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $297.14 / $460.13 / $1,505.50	Professional		$297.14	$460.13	$1,505.50
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $79.27 / $112.90 / $492.24	Professional	26	$79.27	$112.90	$492.24
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $218.54 / $344.52 / $1,047.04	Professional	TC	$218.54	$344.52	$1,047.04
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 $309.33 / $317.94 / $341.81	Professional		$309.33	$317.94	$341.81
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $79.83 / $81.54 / $85.88	Professional	26	$79.83	$81.54	$85.88
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $227.81 / $238.11 / $255.93	Professional	TC	$227.81	$238.11	$255.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $87.81 / $315.38	Professional		$32.34	$87.81	$315.38
United Facility/Professional Professional Modifier Low / Median / High Price $270.06 / $414.32 / $654.35	Professional		$270.06	$414.32	$654.35
United Facility/Professional Professional Modifier 26 Low / Median / High Price $68.11 / $87.64 / $147.27	Professional	26	$68.11	$87.64	$147.27
United Facility/Professional Professional Modifier TC Low / Median / High Price $203.39 / $327.42 / $522.14	Professional	TC	$203.39	$327.42	$522.14