Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $99.08 / $174.18 / $302.33	Facility	26	$99.08	$174.18	$302.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $120.87 / $197.32 / $476.75	Professional		$120.87	$197.32	$476.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $90.92 / $140.02 / $379.56	Professional	26	$90.92	$140.02	$379.56
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.90 / $72.90 / $145.90	Professional	TC	$26.90	$72.90	$145.90
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $147.77 / $147.77 / $154.02	Professional		$147.77	$147.77	$154.02
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $78.05 / $108.12 / $130.09	Professional	26	$78.05	$108.12	$130.09
BCBS Facility/Professional Professional Modifier Low / Median / High Price $135.66 / $250.46 / $335.72	Professional		$135.66	$250.46	$335.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $137.11 / $221.65 / $621.37	Professional		$137.11	$221.65	$621.37
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $99.87 / $146.35 / $230.34	Professional	26	$99.87	$146.35	$230.34
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $32.85 / $59.77 / $478.28	Professional	TC	$32.85	$59.77	$478.28
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $151.50 / $258.60 / $1,617.29	Professional		$151.50	$258.60	$1,617.29
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $119.25 / $173.46 / $1,481.22	Professional	26	$119.25	$173.46	$1,481.22
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $42.83 / $66.91 / $1,481.22	Professional	TC	$42.83	$66.91	$1,481.22
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 $178.10 / $178.23 / $192.10	Professional		$178.10	$178.23	$192.10
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $131.55 / $132.96 / $140.93	Professional	26	$131.55	$132.96	$140.93
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $45.27 / $46.55 / $51.17	Professional	TC	$45.27	$46.55	$51.17
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $57.86 / $200.97	Professional		$32.34	$57.86	$200.97
United Facility/Professional Professional Modifier Low / Median / High Price $143.02 / $218.82 / $475.01	Professional		$143.02	$218.82	$475.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $106.28 / $138.85 / $275.17	Professional	26	$106.28	$138.85	$275.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.31 / $46.02 / $287.77	Professional	TC	$27.31	$46.02	$287.77