Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.05 / $30.20 / $60.26	Facility	26	$19.05	$30.20	$60.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $109.65 / $239.88	Professional		$72.44	$109.65	$239.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $28.84 / $67.61	Professional	26	$16.98	$28.84	$67.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $75.86 / $154.88	Professional	TC	$54.95	$75.86	$154.88
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $74.13 / $112.20	Professional		$61.66	$74.13	$112.20
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $15.14 / $31.62	Professional	26	$15.14	$15.14	$31.62
BCBS Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $91.20 / $199.53	Professional		$25.12	$91.20	$199.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $114.82 / $177.83	Professional		$75.86	$114.82	$177.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $27.54 / $39.81	Professional	26	$16.98	$27.54	$39.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $89.13 / $141.25	Professional	TC	$57.54	$89.13	$141.25
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $158.49 / $436.52	Professional		$102.33	$158.49	$436.52
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $30.90 / $117.49	Professional	26	$22.39	$30.90	$117.49
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $112.20 / $275.42	Professional	TC	$77.62	$112.20	$275.42
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 $114.82 / $117.49 / $128.82	Professional		$114.82	$117.49	$128.82
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $24.55 / $26.30	Professional	26	$22.39	$24.55	$26.30
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $91.20 / $102.33	Professional	TC	$87.10	$91.20	$102.33
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 $79.43 / $104.71 / $162.18	Professional		$79.43	$104.71	$162.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $24.55 / $38.02	Professional	26	$19.95	$24.55	$38.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $81.28 / $125.89	Professional	TC	$58.88	$81.28	$125.89