Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.42 / $77.48 / $92.21	Facility	26	$49.42	$77.48	$92.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $83.04 / $183.43 / $495.51	Professional		$83.04	$183.43	$495.51
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.82 / $61.45 / $254.38	Professional	26	$43.82	$61.45	$254.38
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $119.94 / $119.94 / $138.40	Professional	50	$119.94	$119.94	$138.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $86.44 / $147.47 / $240.00	Professional	TC	$86.44	$147.47	$240.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $78.65 / $117.46 / $232.65	Professional		$78.65	$117.46	$232.65
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $34.57 / $44.81 / $63.59	Professional	26	$34.57	$44.81	$63.59
BCBS Facility/Professional Professional Modifier Low / Median / High Price $58.94 / $153.46 / $294.17	Professional		$58.94	$153.46	$294.17
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $63.49 / $63.49 / $63.49	Facility	26	$63.49	$63.49	$63.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $133.34 / $214.10 / $379.00	Professional		$133.34	$214.10	$379.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.15 / $64.98 / $99.64	Professional	26	$40.15	$64.98	$99.64
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $231.80 / $231.80 / $264.70	Professional	50	$231.80	$231.80	$264.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $83.67 / $140.79 / $282.08	Professional	TC	$83.67	$140.79	$282.08
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $149.53 / $237.24 / $1,209.10	Professional		$149.53	$237.24	$1,209.10
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $56.52 / $80.55 / $305.83	Professional	26	$56.52	$80.55	$305.83
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $96.11 / $150.76 / $956.38	Professional	TC	$96.11	$150.76	$956.38
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 $156.16 / $159.44 / $171.34	Professional		$156.16	$159.44	$171.34
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $57.10 / $58.18 / $61.23	Professional	26	$57.10	$58.18	$61.23
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $97.99 / $102.35 / $110.11	Professional	TC	$97.99	$102.35	$110.11
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $64.06 / $179.25	Professional		$32.34	$64.06	$179.25
United Facility/Professional Professional Modifier Low / Median / High Price $156.05 / $236.03 / $361.36	Professional		$156.05	$236.03	$361.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.23 / $68.45 / $128.16	Professional	26	$51.23	$68.45	$128.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $105.02 / $176.64 / $263.79	Professional	TC	$105.02	$176.64	$263.79