Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $91.92 / $143.96 / $317.08	Facility	26	$91.92	$143.96	$317.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $301.14 / $369.36 / $1,166.50	Professional		$301.14	$369.36	$1,166.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $81.01 / $123.36 / $360.00	Professional	26	$81.01	$123.36	$360.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $218.29 / $260.58 / $416.80	Professional	TC	$218.29	$260.58	$416.80
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $211.91 / $276.97 / $360.06	Professional		$211.91	$276.97	$360.06
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $63.12 / $85.65 / $118.33	Professional	26	$63.12	$85.65	$118.33
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $171.77 / $229.23 / $265.75	Professional	TC	$171.77	$229.23	$265.75
BCBS Facility/Professional Professional Modifier Low / Median / High Price $109.69 / $355.26 / $681.03	Professional		$109.69	$355.26	$681.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $109.57 / $109.57 / $109.57	Facility	26	$109.57	$109.57	$109.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $262.39 / $420.70 / $653.97	Professional		$262.39	$420.70	$653.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $71.27 / $116.20 / $173.94	Professional	26	$71.27	$116.20	$173.94
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $186.44 / $307.12 / $470.38	Professional	TC	$186.44	$307.12	$470.38
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $343.44 / $500.60 / $1,843.08	Professional		$343.44	$500.60	$1,843.08
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $100.15 / $149.06 / $664.21	Professional	26	$100.15	$149.06	$664.21
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $243.64 / $366.35 / $1,174.75	Professional	TC	$243.64	$366.35	$1,174.75
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 $361.54 / $369.95 / $399.13	Professional		$361.54	$369.95	$399.13
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $104.48 / $107.65 / $113.95	Professional	26	$104.48	$107.65	$113.95
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $253.89 / $265.47 / $285.18	Professional	TC	$253.89	$265.47	$285.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $119.20 / $417.55	Professional		$32.34	$119.20	$417.55
United Facility/Professional Professional Modifier Low / Median / High Price $317.31 / $416.37 / $621.10	Professional		$317.31	$416.37	$621.10
United Facility/Professional Professional Modifier 26 Low / Median / High Price $89.21 / $116.31 / $190.84	Professional	26	$89.21	$116.31	$190.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $226.97 / $301.11 / $445.69	Professional	TC	$226.97	$301.11	$445.69