Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $88.14 / $136.05 / $248.25	Facility	26	$88.14	$136.05	$248.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $184.40 / $228.69 / $594.25	Professional		$184.40	$228.69	$594.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.06 / $101.32 / $257.45	Professional	26	$77.06	$101.32	$257.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $103.74 / $128.97 / $212.21	Professional	TC	$103.74	$128.97	$212.21
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $126.04 / $169.69 / $220.60	Professional		$126.04	$169.69	$220.60
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $59.58 / $72.17 / $111.71	Professional	26	$59.58	$72.17	$111.71
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $81.70 / $108.85 / $126.04	Professional	TC	$81.70	$108.85	$126.04
BCBS Facility/Professional Professional Modifier Low / Median / High Price $103.55 / $218.92 / $419.66	Professional		$103.55	$218.92	$419.66
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.70 / $104.70 / $104.70	Facility	26	$104.70	$104.70	$104.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $169.02 / $265.24 / $414.82	Professional		$169.02	$265.24	$414.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.09 / $111.71 / $171.01	Professional	26	$69.09	$111.71	$171.01
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $97.58 / $156.12 / $232.79	Professional	TC	$97.58	$156.12	$232.79
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $210.64 / $317.02 / $1,262.91	Professional		$210.64	$317.02	$1,262.91
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $95.41 / $141.19 / $584.19	Professional	26	$95.41	$141.19	$584.19
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $116.70 / $177.03 / $705.60	Professional	TC	$116.70	$177.03	$705.60
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 $222.78 / $225.47 / $243.48	Professional		$222.78	$225.47	$243.48
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $99.63 / $101.97 / $107.58	Professional	26	$99.63	$101.97	$107.58
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $120.81 / $125.84 / $135.91	Professional	TC	$120.81	$125.84	$135.91
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $109.82 / $254.71	Professional		$32.34	$109.82	$254.71
United Facility/Professional Professional Modifier Low / Median / High Price $201.53 / $265.39 / $406.36	Professional		$201.53	$265.39	$406.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $85.09 / $107.58 / $182.23	Professional	26	$85.09	$107.58	$182.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $112.86 / $152.74 / $231.49	Professional	TC	$112.86	$152.74	$231.49