Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $128.35 / $215.30 / $303.58	Facility	26	$128.35	$215.30	$303.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $376.07 / $475.00 / $827.73	Professional		$376.07	$475.00	$827.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $119.21 / $153.71 / $389.19	Professional	26	$119.21	$153.71	$389.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $260.02 / $335.00 / $478.81	Professional	TC	$260.02	$335.00	$478.81
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $218.34 / $347.49 / $347.49	Professional		$218.34	$347.49	$347.49
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $92.68 / $147.56 / $166.01	Professional	26	$92.68	$147.56	$166.01
BCBS Facility/Professional Professional Modifier Low / Median / High Price $153.88 / $425.75 / $816.16	Professional		$153.88	$425.75	$816.16
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $161.60 / $161.60 / $161.60	Facility	26	$161.60	$161.60	$161.60
Cigna Facility/Professional Professional Modifier Low / Median / High Price $362.65 / $560.72 / $1,040.50	Professional		$362.65	$560.72	$1,040.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $103.84 / $166.00 / $254.35	Professional	26	$103.84	$166.00	$254.35
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $240.53 / $379.89 / $808.07	Professional	TC	$240.53	$379.89	$808.07
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $403.13 / $612.02 / $3,282.08	Professional		$403.13	$612.02	$3,282.08
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $141.78 / $209.88 / $830.49	Professional	26	$141.78	$209.88	$830.49
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $267.87 / $365.28 / $2,102.19	Professional	TC	$267.87	$365.28	$2,102.19
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 $433.28 / $442.21 / $476.42	Professional		$433.28	$442.21	$476.42
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $148.02 / $151.58 / $159.86	Professional	26	$148.02	$151.58	$159.86
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $269.08 / $281.70 / $316.58	Professional	TC	$269.08	$281.70	$316.58
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $167.24 / $498.41	Professional		$32.34	$167.24	$498.41
United Facility/Professional Professional Modifier Low / Median / High Price $422.56 / $651.24 / $1,058.99	Professional		$422.56	$651.24	$1,058.99
United Facility/Professional Professional Modifier 26 Low / Median / High Price $123.77 / $156.55 / $256.26	Professional	26	$123.77	$156.55	$256.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $292.33 / $451.56 / $736.05	Professional	TC	$292.33	$451.56	$736.05