Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $141.25 / $794.33	Facility	26	$91.20	$141.25	$794.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $436.52 / $1,548.82	Professional		$281.84	$436.52	$1,548.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $107.15 / $346.74	Professional	26	$79.43	$107.15	$346.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $281.84 / $660.69	Professional	TC	$204.17	$281.84	$660.69
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $239.88 / $478.63	Professional		$199.53	$239.88	$478.63
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $81.28 / $128.82	Professional	26	$64.57	$81.28	$128.82
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $199.53 / $302.00	Professional	TC	$147.91	$199.53	$302.00
BCBS Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $354.81 / $676.08	Professional		$109.65	$354.81	$676.08
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $109.65 / $109.65 / $109.65	Facility	26	$109.65	$109.65	$109.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $416.87 / $645.65	Professional		$257.04	$416.87	$645.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $117.49 / $173.78	Professional	26	$70.79	$117.49	$173.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $309.03 / $467.74	Professional	TC	$181.97	$309.03	$467.74
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $691.83 / $1,862.09	Professional		$338.84	$691.83	$1,862.09
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $218.78 / $891.25	Professional	26	$100.00	$218.78	$891.25
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $489.78 / $1,258.93	Professional	TC	$245.47	$489.78	$1,258.93
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 / $398.11	Professional		$363.08	$371.54	$398.11
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $107.15 / $114.82	Professional	26	$104.71	$107.15	$114.82
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $263.03 / $288.40	Professional	TC	$251.19	$263.03	$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 / $398.11 / $588.84	Professional		$309.03	$398.11	$588.84
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 / $288.40 / $426.58	Professional	TC	$218.78	$288.40	$426.58