Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.79 / $51.64 / $67.89	Facility	26	$37.79	$51.64	$67.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $171.20 / $224.58 / $535.96	Professional		$171.20	$224.58	$535.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.13 / $45.23 / $124.87	Professional	26	$31.13	$45.23	$124.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $139.01 / $169.96 / $334.53	Professional	TC	$139.01	$169.96	$334.53
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $121.23 / $144.16 / $210.02	Professional		$121.23	$144.16	$210.02
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $27.28 / $33.18 / $49.03	Professional	26	$27.28	$33.18	$49.03
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $110.03 / $179.84 / $180.60	Professional	TC	$110.03	$179.84	$180.60
BCBS Facility/Professional Professional Modifier Low / Median / High Price $42.78 / $138.58 / $330.89	Professional		$42.78	$138.58	$330.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $187.59 / $266.02 / $407.35	Professional		$187.59	$266.02	$407.35
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.42 / $49.38 / $72.14	Professional	26	$32.42	$49.38	$72.14
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $147.86 / $216.63 / $335.36	Professional	TC	$147.86	$216.63	$335.36
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $203.32 / $293.11 / $727.98	Professional		$203.32	$293.11	$727.98
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $41.57 / $58.73 / $195.66	Professional	26	$41.57	$58.73	$195.66
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $164.86 / $226.07 / $532.32	Professional	TC	$164.86	$226.07	$532.32
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 $208.24 / $220.26 / $244.99	Professional		$208.24	$220.26	$244.99
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $42.63 / $44.94 / $50.15	Professional	26	$42.63	$44.94	$50.15
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $165.61 / $173.17 / $194.83	Professional	TC	$165.61	$173.17	$194.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $52.47 / $256.29	Professional		$32.34	$52.47	$256.29
United Facility/Professional Professional Modifier Low / Median / High Price $201.81 / $279.72 / $443.34	Professional		$201.81	$279.72	$443.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.31 / $46.41 / $86.46	Professional	26	$32.31	$46.41	$86.46
United Facility/Professional Professional Modifier TC Low / Median / High Price $161.24 / $237.62 / $389.57	Professional	TC	$161.24	$237.62	$389.57