Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.81 / $111.00 / $181.27	Facility	26	$75.81	$111.00	$181.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $190.43 / $235.98 / $942.49	Professional		$190.43	$235.98	$942.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.63 / $95.41 / $330.00	Professional	26	$69.63	$95.41	$330.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $118.09 / $148.83 / $244.66	Professional	TC	$118.09	$148.83	$244.66
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $162.47 / $162.47 / $162.47	Professional		$162.47	$162.47	$162.47
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $60.64 / $80.84 / $90.95	Professional	26	$60.64	$80.84	$90.95
BCBS Facility/Professional Professional Modifier Low / Median / High Price $74.72 / $184.58 / $367.47	Professional		$74.72	$184.58	$367.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $175.55 / $249.32 / $410.27	Professional		$175.55	$249.32	$410.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $96.90 / $149.37	Professional	26	$70.79	$96.90	$149.37
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $100.84 / $157.33 / $257.10	Professional	TC	$100.84	$157.33	$257.10
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $185.82 / $282.30 / $738.92	Professional		$185.82	$282.30	$738.92
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $74.11 / $104.42 / $408.39	Professional	26	$74.11	$104.42	$408.39
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $102.08 / $160.72 / $469.66	Professional	TC	$102.08	$160.72	$469.66
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 $216.36 / $221.18 / $236.83	Professional		$216.36	$221.18	$236.83
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $82.88 / $83.66 / $87.58	Professional	26	$82.88	$83.66	$87.58
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $132.69 / $138.31 / $149.25	Professional	TC	$132.69	$138.31	$149.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $91.62 / $247.76	Professional		$32.34	$91.62	$247.76
United Facility/Professional Professional Modifier Low / Median / High Price $183.77 / $252.59 / $393.22	Professional		$183.77	$252.59	$393.22
United Facility/Professional Professional Modifier 26 Low / Median / High Price $71.92 / $97.14 / $155.96	Professional	26	$71.92	$97.14	$155.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $114.39 / $165.91 / $253.82	Professional	TC	$114.39	$165.91	$253.82