Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $151.36 / $263.03	Facility	26	$91.20	$151.36	$263.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $380.19 / $1,122.02	Professional		$251.19	$380.19	$1,122.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $131.83 / $331.13	Professional	26	$77.62	$131.83	$331.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $234.42 / $537.03	Professional	TC	$162.18	$234.42	$537.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $64.57 / $87.10	Professional	26	$39.81	$64.57	$87.10
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $229.09 / $229.09	Professional	TC	$229.09	$229.09	$229.09
BCBS Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $309.03 / $691.83	Professional		$109.65	$309.03	$691.83
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $117.49 / $117.49 / $117.49	Facility	26	$117.49	$117.49	$117.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $467.74 / $812.83	Professional		$275.42	$467.74	$812.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $117.49 / $177.83	Professional	26	$74.13	$117.49	$177.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $331.13 / $645.65	Professional	TC	$190.55	$331.13	$645.65
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $691.83 / $2,089.30	Professional		$346.74	$691.83	$2,089.30
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $173.78 / $691.83	Professional	26	$100.00	$173.78	$691.83
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $478.63 / $1,513.56	Professional	TC	$257.04	$478.63	$1,513.56
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 $363.08 / $371.54 / $407.38	Professional		$363.08	$371.54	$407.38
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $107.15 / $112.20	Professional	26	$104.71	$107.15	$112.20
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $269.15 / $288.40	Professional	TC	$257.04	$269.15	$288.40
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 $309.03 / $478.63 / $776.25	Professional		$309.03	$478.63	$776.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $109.65 / $165.96	Professional	26	$83.18	$109.65	$165.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $354.81 / $616.60	Professional	TC	$218.78	$354.81	$616.60