Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.81 / $100.52 / $119.81	Facility	26	$64.81	$100.52	$119.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $157.09 / $232.78 / $371.18	Professional		$157.09	$232.78	$371.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.15 / $66.47 / $136.01	Professional	26	$55.15	$66.47	$136.01
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $94.05 / $159.63 / $240.00	Professional	TC	$94.05	$159.63	$240.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $91.28 / $144.88 / $180.09	Professional		$91.28	$144.88	$180.09
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $45.61 / $61.16 / $82.57	Professional	26	$45.61	$61.16	$82.57
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $47.86 / $47.86	Professional	TC	$47.86	$47.86	$47.86
BCBS Facility/Professional Professional Modifier Low / Median / High Price $76.54 / $178.23 / $341.66	Professional		$76.54	$178.23	$341.66
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $78.89 / $78.89 / $78.89	Facility	26	$78.89	$78.89	$78.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $154.87 / $236.86 / $403.29	Professional		$154.87	$236.86	$403.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.32 / $82.57 / $124.17	Professional	26	$51.32	$82.57	$124.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $90.54 / $146.82 / $278.98	Professional	TC	$90.54	$146.82	$278.98
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $173.16 / $275.06 / $955.63	Professional		$173.16	$275.06	$955.63
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $73.39 / $104.31 / $429.01	Professional	26	$73.39	$104.31	$429.01
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $104.00 / $160.38 / $631.82	Professional	TC	$104.00	$160.38	$631.82
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 $181.38 / $184.38 / $198.65	Professional		$181.38	$184.38	$198.65
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $73.58 / $75.34 / $79.51	Professional	26	$73.58	$75.34	$79.51
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $106.04 / $110.80 / $119.15	Professional	TC	$106.04	$110.80	$119.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $81.56 / $207.82	Professional		$32.34	$81.56	$207.82
United Facility/Professional Professional Modifier Low / Median / High Price $165.68 / $249.92 / $383.76	Professional		$165.68	$249.92	$383.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $63.99 / $86.00 / $163.97	Professional	26	$63.99	$86.00	$163.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $101.41 / $165.51 / $256.32	Professional	TC	$101.41	$165.51	$256.32