Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $87.10 / $125.89 / $144.54	Facility	26	$87.10	$125.89	$144.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $380.19 / $1,096.48	Professional		$229.09	$380.19	$1,096.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $131.83 / $380.19	Professional	26	$79.43	$131.83	$380.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $177.83 / $363.08	Professional	TC	$138.04	$177.83	$363.08
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $213.80 / $275.42	Professional		$194.98	$213.80	$275.42
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $93.33 / $141.25	Professional	26	$79.43	$93.33	$141.25
BCBS Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $218.78 / $457.09	Professional		$89.13	$218.78	$457.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $331.13 / $512.86	Professional		$229.09	$331.13	$512.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $117.49 / $186.21	Professional	26	$85.11	$117.49	$186.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $204.17 / $338.84	Professional	TC	$151.36	$204.17	$338.84
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $416.87 / $1,202.26	Professional		$239.88	$416.87	$1,202.26
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $147.91 / $549.54	Professional	26	$89.13	$147.91	$549.54
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $251.19 / $776.25	Professional	TC	$158.49	$251.19	$776.25
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 $269.15 / $275.42 / $302.00	Professional		$269.15	$275.42	$302.00
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $100.00 / $104.71	Professional	26	$100.00	$100.00	$104.71
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $177.83 / $194.98	Professional	TC	$173.78	$177.83	$194.98
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 $229.09 / $302.00 / $457.09	Professional		$229.09	$302.00	$457.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $109.65 / $169.82	Professional	26	$83.18	$109.65	$169.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $194.98 / $295.12	Professional	TC	$144.54	$194.98	$295.12