Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.70 / $75.86 / $147.91	Facility	26	$53.70	$75.86	$147.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $371.54 / $1,148.15	Professional		$245.47	$371.54	$1,148.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $100.00 / $323.59	Professional	26	$53.70	$100.00	$323.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $234.42 / $446.68	Professional	TC	$173.78	$234.42	$446.68
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $213.80 / $331.13	Professional		$173.78	$213.80	$331.13
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $56.23 / $83.18	Professional	26	$40.74	$56.23	$83.18
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $194.98 / $281.84	Professional	TC	$151.36	$194.98	$281.84
BCBS Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $223.87 / $457.09	Professional		$61.66	$223.87	$457.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $380.19 / $630.96	Professional		$263.03	$380.19	$630.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $85.11 / $151.36	Professional	26	$56.23	$85.11	$151.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $295.12 / $524.81	Professional	TC	$208.93	$295.12	$524.81
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $426.58 / $1,047.13	Professional		$275.42	$426.58	$1,047.13
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $109.65 / $426.58	Professional	26	$61.66	$109.65	$426.58
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $288.40 / $630.96	Professional	TC	$208.93	$288.40	$630.96
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 $309.03 / $316.23 / $338.84	Professional		$309.03	$316.23	$338.84
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $67.61 / $72.44	Professional	26	$64.57	$67.61	$72.44
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $245.47 / $269.15	Professional	TC	$239.88	$245.47	$269.15
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 $269.15 / $380.19 / $588.84	Professional		$269.15	$380.19	$588.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $87.10 / $141.25	Professional	26	$56.23	$87.10	$141.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $295.12 / $457.09	Professional	TC	$208.93	$295.12	$457.09