Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $110.09 / $173.51 / $203.47	Facility	26	$110.09	$173.51	$203.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $380.39 / $512.36 / $837.86	Professional		$380.39	$512.36	$837.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $91.25 / $135.10 / $609.90	Professional	26	$91.25	$135.10	$609.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $275.27 / $390.02 / $534.96	Professional	TC	$275.27	$390.02	$534.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $229.74 / $348.21 / $366.01	Professional		$229.74	$348.21	$366.01
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $76.48 / $98.78 / $142.60	Professional	26	$76.48	$98.78	$142.60
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $240.32 / $340.25 / $340.25	Professional	TC	$240.32	$340.25	$340.25
BCBS Facility/Professional Professional Modifier Low / Median / High Price $132.19 / $447.30 / $857.46	Professional		$132.19	$447.30	$857.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $330.01 / $580.78 / $907.72	Professional		$330.01	$580.78	$907.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $86.38 / $141.90 / $208.09	Professional	26	$86.38	$141.90	$208.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $239.95 / $422.35 / $737.49	Professional	TC	$239.95	$422.35	$737.49
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $425.91 / $646.61 / $2,332.56	Professional		$425.91	$646.61	$2,332.56
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $120.21 / $179.57 / $1,012.99	Professional	26	$120.21	$179.57	$1,012.99
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $309.72 / $422.34 / $1,365.35	Professional	TC	$309.72	$422.34	$1,365.35
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 $455.21 / $465.10 / $503.35	Professional		$455.21	$465.10	$503.35
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $125.31 / $129.58 / $137.32	Professional	26	$125.31	$129.58	$137.32
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $311.12 / $325.61 / $366.03	Professional	TC	$311.12	$325.61	$366.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $143.66 / $526.58	Professional		$32.34	$143.66	$526.58
United Facility/Professional Professional Modifier Low / Median / High Price $407.96 / $604.15 / $863.15	Professional		$407.96	$604.15	$863.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $108.50 / $135.78 / $223.76	Professional	26	$108.50	$135.78	$223.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $293.97 / $447.58 / $700.08	Professional	TC	$293.97	$447.58	$700.08