Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.66 / $133.13 / $217.66	Facility	26	$93.66	$133.13	$217.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $238.30 / $302.23 / $1,085.74	Professional		$238.30	$302.23	$1,085.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.53 / $103.09 / $366.33	Professional	26	$79.53	$103.09	$366.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $151.06 / $175.02 / $279.43	Professional	TC	$151.06	$175.02	$279.43
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $196.24 / $204.52 / $264.10	Professional		$196.24	$204.52	$264.10
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $84.82 / $92.90 / $105.82	Professional	26	$84.82	$92.90	$105.82
BCBS Facility/Professional Professional Modifier Low / Median / High Price $89.59 / $216.49 / $462.14	Professional		$89.59	$216.49	$462.14
Cigna Facility/Professional Professional Modifier Low / Median / High Price $230.20 / $337.59 / $487.63	Professional		$230.20	$337.59	$487.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.84 / $117.74 / $179.46	Professional	26	$84.84	$117.74	$179.46
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $148.87 / $200.98 / $321.16	Professional	TC	$148.87	$200.98	$321.16
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $245.63 / $355.96 / $1,109.44	Professional		$245.63	$355.96	$1,109.44
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $88.86 / $127.03 / $499.32	Professional	26	$88.86	$127.03	$499.32
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $151.85 / $226.03 / $677.71	Professional	TC	$151.85	$226.03	$677.71
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 $272.10 / $277.67 / $298.55	Professional		$272.10	$277.67	$298.55
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $99.23 / $100.27 / $105.01	Professional	26	$99.23	$100.27	$105.01
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $171.83 / $178.43 / $193.53	Professional	TC	$171.83	$178.43	$193.53
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $109.86 / $312.32	Professional		$32.34	$109.86	$312.32
United Facility/Professional Professional Modifier Low / Median / High Price $235.99 / $327.05 / $486.31	Professional		$235.99	$327.05	$486.31
United Facility/Professional Professional Modifier 26 Low / Median / High Price $86.18 / $118.69 / $191.91	Professional	26	$86.18	$118.69	$191.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $150.85 / $207.40 / $299.48	Professional	TC	$150.85	$207.40	$299.48