Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.14 / $99.46 / $118.50	Facility	26	$64.14	$99.46	$118.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $174.37 / $281.67 / $455.94	Professional		$174.37	$281.67	$455.94
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.86 / $67.01 / $161.90	Professional	26	$54.86	$67.01	$161.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $116.38 / $194.89 / $282.38	Professional	TC	$116.38	$194.89	$282.38
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $118.35 / $131.50 / $176.73	Professional		$118.35	$131.50	$176.73
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $44.59 / $60.51 / $81.69	Professional	26	$44.59	$60.51	$81.69
BCBS Facility/Professional Professional Modifier Low / Median / High Price $75.72 / $205.14 / $393.25	Professional		$75.72	$205.14	$393.25
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $78.48 / $78.48 / $78.48	Facility	26	$78.48	$78.48	$78.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $173.64 / $275.55 / $503.02	Professional		$173.64	$275.55	$503.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.74 / $82.71 / $125.48	Professional	26	$50.74	$82.71	$125.48
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $111.78 / $181.16 / $371.66	Professional	TC	$111.78	$181.16	$371.66
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $199.43 / $317.95 / $1,266.58	Professional		$199.43	$317.95	$1,266.58
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $72.61 / $103.19 / $464.46	Professional	26	$72.61	$103.19	$464.46
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $131.66 / $206.52 / $897.23	Professional	TC	$131.66	$206.52	$897.23
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 $208.77 / $212.67 / $229.63	Professional		$208.77	$212.67	$229.63
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $72.75 / $74.53 / $78.66	Professional	26	$72.75	$74.53	$78.66
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $134.24 / $139.91 / $150.97	Professional	TC	$134.24	$139.91	$150.97
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $82.29 / $240.23	Professional		$32.34	$82.29	$240.23
United Facility/Professional Professional Modifier Low / Median / High Price $192.40 / $295.89 / $483.39	Professional		$192.40	$295.89	$483.39
United Facility/Professional Professional Modifier 26 Low / Median / High Price $61.90 / $79.33 / $132.46	Professional	26	$61.90	$79.33	$132.46
United Facility/Professional Professional Modifier TC Low / Median / High Price $127.82 / $198.32 / $349.34	Professional	TC	$127.82	$198.32	$349.34