Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.80 / $22.91 / $45.71	Facility	26	$13.80	$22.91	$45.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $91.20 / $269.15	Professional		$57.54	$91.20	$269.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $24.55 / $69.18	Professional	26	$13.18	$24.55	$69.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $57.54 / $120.23	Professional	TC	$42.66	$57.54	$120.23
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $52.48 / $95.50	Professional		$45.71	$52.48	$95.50
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $16.22 / $22.39	Professional	26	$11.48	$16.22	$22.39
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $56.23 / $63.10	Professional	TC	$56.23	$56.23	$63.10
BCBS Facility/Professional Professional Modifier Low / Median / High Price $19.05 / $81.28 / $141.25	Professional		$19.05	$81.28	$141.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $83.18 / $128.82	Professional		$56.23	$83.18	$128.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $20.89 / $31.62	Professional	26	$12.88	$20.89	$31.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $64.57 / $100.00	Professional	TC	$42.66	$64.57	$100.00
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $186.21 / $323.59	Professional		$83.18	$186.21	$323.59
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $46.77 / $107.15	Professional	26	$18.20	$46.77	$107.15
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $102.33 / $229.09	Professional	TC	$63.10	$102.33	$229.09
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 $83.18 / $85.11 / $91.20	Professional		$83.18	$85.11	$91.20
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $18.62 / $19.95	Professional	26	$18.20	$18.62	$19.95
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $66.07 / $72.44	Professional	TC	$64.57	$66.07	$72.44
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 $60.26 / $77.62 / $117.49	Professional		$60.26	$77.62	$117.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $19.50 / $29.51	Professional	26	$15.49	$19.50	$29.51
United Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $58.88 / $89.13	Professional	TC	$43.65	$58.88	$89.13