Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.09 / $30.78 / $39.83	Facility	26	$16.09	$30.78	$39.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $61.64 / $74.09 / $125.56	Professional		$61.64	$74.09	$125.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.89 / $16.30 / $30.78	Professional	26	$14.89	$16.30	$30.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $46.00 / $54.32 / $93.15	Professional	TC	$46.00	$54.32	$93.15
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $59.33 / $59.33 / $65.83	Professional		$59.33	$59.33	$65.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $16.69 / $19.57 / $20.42	Professional	26	$16.69	$19.57	$20.42
BCBS Facility/Professional Professional Modifier Low / Median / High Price $21.30 / $92.30 / $162.37	Professional		$21.30	$92.30	$162.37
Cigna Facility/Professional Professional Modifier Low / Median / High Price $63.15 / $99.17 / $149.97	Professional		$63.15	$99.17	$149.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.33 / $22.97 / $35.92	Professional	26	$14.33	$22.97	$35.92
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $47.63 / $75.20 / $118.16	Professional	TC	$47.63	$75.20	$118.16
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $92.12 / $130.22 / $372.93	Professional		$92.12	$130.22	$372.93
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.72 / $25.90 / $60.75	Professional	26	$18.72	$25.90	$60.75
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $69.50 / $94.77 / $200.00	Professional	TC	$69.50	$94.77	$200.00
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 $93.93 / $96.42 / $104.26	Professional		$93.93	$96.42	$104.26
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.80 / $20.89 / $22.13	Professional	26	$18.80	$20.89	$22.13
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $69.81 / $72.88 / $82.13	Professional	TC	$69.81	$72.88	$82.13
Molina Facility/Professional Professional Modifier Low / Median / High Price $23.15 / $32.34 / $109.07	Professional		$23.15	$32.34	$109.07
United Facility/Professional Professional Modifier Low / Median / High Price $68.53 / $91.72 / $146.82	Professional		$68.53	$91.72	$146.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.57 / $22.61 / $34.74	Professional	26	$17.57	$22.61	$34.74
United Facility/Professional Professional Modifier TC Low / Median / High Price $50.91 / $70.67 / $117.88	Professional	TC	$50.91	$70.67	$117.88