Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $72.44 / $120.23 / $208.93	Facility	26	$72.44	$120.23	$208.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $426.58 / $1,445.44	Professional		$204.17	$426.58	$1,445.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $125.89 / $331.13	Professional	26	$69.18	$125.89	$331.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $263.03 / $562.34	Professional	TC	$134.90	$263.03	$562.34
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $151.36 / $173.78	Professional		$141.25	$151.36	$173.78
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $64.57 / $109.65	Professional	26	$51.29	$64.57	$109.65
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $162.18 / $162.18	Professional	TC	$162.18	$162.18	$162.18
BCBS Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $229.09 / $446.68	Professional		$87.10	$229.09	$446.68
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $89.13 / $89.13	Facility	26	$89.13	$89.13	$89.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $389.05 / $724.44	Professional		$204.17	$389.05	$724.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $97.72 / $151.36	Professional	26	$58.88	$97.72	$151.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $275.42 / $602.56	Professional	TC	$134.90	$275.42	$602.56
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $602.56 / $2,290.87	Professional		$218.78	$602.56	$2,290.87
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $138.04 / $794.33	Professional	26	$81.28	$138.04	$794.33
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $489.78 / $1,698.24	Professional	TC	$147.91	$489.78	$1,698.24
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 $234.42 / $239.88 / $257.04	Professional		$234.42	$239.88	$257.04
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $85.11 / $89.13	Professional	26	$83.18	$85.11	$89.13
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $154.88 / $169.82	Professional	TC	$151.36	$154.88	$169.82
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 $218.78 / $398.11 / $691.83	Professional		$218.78	$398.11	$691.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $87.10 / $134.90	Professional	26	$67.61	$87.10	$134.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $275.42 / $562.34	Professional	TC	$144.54	$275.42	$562.34