Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $73.75 / $119.43 / $173.01	Facility	26	$73.75	$119.43	$173.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $209.17 / $402.08 / $630.00	Professional		$209.17	$402.08	$630.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $73.75 / $126.00 / $364.00	Professional	26	$73.75	$126.00	$364.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $142.74 / $262.50 / $433.05	Professional	TC	$142.74	$262.50	$433.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $129.11 / $176.92 / $188.48	Professional		$129.11	$176.92	$188.48
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $50.52 / $65.20 / $93.60	Professional	26	$50.52	$65.20	$93.60
BCBS Facility/Professional Professional Modifier Low / Median / High Price $86.77 / $231.27 / $443.35	Professional		$86.77	$231.27	$443.35
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $89.81 / $89.81 / $89.81	Facility	26	$89.81	$89.81	$89.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $200.96 / $354.27 / $728.62	Professional		$200.96	$354.27	$728.62
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.15 / $96.13 / $145.88	Professional	26	$58.15	$96.13	$145.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $128.04 / $230.86 / $590.10	Professional	TC	$128.04	$230.86	$590.10
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $224.83 / $348.30 / $1,946.72	Professional		$224.83	$348.30	$1,946.72
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $83.20 / $118.24 / $588.52	Professional	26	$83.20	$118.24	$588.52
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $147.07 / $230.70 / $1,525.39	Professional	TC	$147.07	$230.70	$1,525.39
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 $235.37 / $239.71 / $258.74	Professional		$235.37	$239.71	$258.74
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $83.29 / $85.40 / $90.13	Professional	26	$83.29	$85.40	$90.13
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $149.96 / $156.41 / $168.61	Professional	TC	$149.96	$156.41	$168.61
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $94.29 / $270.68	Professional		$32.34	$94.29	$270.68
United Facility/Professional Professional Modifier Low / Median / High Price $227.20 / $394.25 / $645.91	Professional		$227.20	$394.25	$645.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $71.11 / $90.08 / $142.51	Professional	26	$71.11	$90.08	$142.51
United Facility/Professional Professional Modifier TC Low / Median / High Price $152.04 / $269.68 / $513.15	Professional	TC	$152.04	$269.68	$513.15