Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.66 / $102.33 / $177.83	Facility	26	$61.66	$102.33	$177.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $275.42 / $676.08	Professional		$169.82	$275.42	$676.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $85.11 / $239.88	Professional	26	$53.70	$85.11	$239.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $173.78 / $426.58	Professional	TC	$114.82	$173.78	$426.58
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $43.65 / $91.20	Professional	26	$42.66	$43.65	$91.20
BCBS Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $199.53 / $354.81	Professional		$72.44	$199.53	$354.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.86 / $75.86 / $75.86	Facility	26	$75.86	$75.86	$75.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $281.84 / $524.81	Professional		$173.78	$281.84	$524.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $79.43 / $117.49	Professional	26	$48.98	$79.43	$117.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $194.98 / $398.11	Professional	TC	$117.49	$194.98	$398.11
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $446.68 / $1,584.89	Professional		$194.98	$446.68	$1,584.89
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $114.82 / $575.44	Professional	26	$69.18	$114.82	$575.44
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $323.59 / $1,096.48	Professional	TC	$131.83	$323.59	$1,096.48
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 $204.17 / $208.93 / $223.87	Professional		$204.17	$208.93	$223.87
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $72.44 / $75.86	Professional	26	$69.18	$72.44	$75.86
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $138.04 / $151.36	Professional	TC	$131.83	$138.04	$151.36
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 $190.55 / $302.00 / $478.63	Professional		$190.55	$302.00	$478.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $72.44 / $112.20	Professional	26	$56.23	$72.44	$112.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $218.78 / $380.19	Professional	TC	$128.82	$218.78	$380.19