Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.90 / $58.88 / $104.71	Facility	26	$30.90	$58.88	$104.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $323.59 / $724.44	Professional		$257.04	$323.59	$724.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $50.12 / $123.03	Professional	26	$30.20	$50.12	$123.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $288.40 / $501.19	Professional	TC	$223.87	$288.40	$501.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $213.80 / $213.80	Professional		$213.80	$213.80	$213.80
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $27.54 / $48.98	Professional	26	$25.70	$27.54	$48.98
BCBS Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $154.88 / $630.96	Professional		$43.65	$154.88	$630.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $407.38 / $691.83	Professional		$263.03	$407.38	$691.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $48.98 / $79.43	Professional	26	$30.90	$48.98	$79.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $363.08 / $645.65	Professional	TC	$245.47	$363.08	$645.65
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $436.52 / $1,148.15	Professional		$281.84	$436.52	$1,148.15
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $54.95 / $229.09	Professional	26	$36.31	$54.95	$229.09
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $354.81 / $758.58	Professional	TC	$251.19	$354.81	$758.58
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 $338.84 / $346.74 / $380.19	Professional		$338.84	$346.74	$380.19
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $42.66 / $45.71	Professional	26	$41.69	$42.66	$45.71
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $295.12 / $331.13	Professional	TC	$281.84	$295.12	$331.13
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 $309.03 / $426.58 / $616.60	Professional		$309.03	$426.58	$616.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $46.77 / $69.18	Professional	26	$35.48	$46.77	$69.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $380.19 / $549.54	Professional	TC	$275.42	$380.19	$549.54