Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.51 / $53.70 / $141.25	Facility	26	$29.51	$53.70	$141.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $120.23 / $323.59	Professional		$77.62	$120.23	$323.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $44.67 / $141.25	Professional	26	$18.20	$44.67	$141.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $67.61 / $213.80	Professional	TC	$41.69	$67.61	$213.80
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $64.57 / $64.57	Professional		$64.57	$64.57	$64.57
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $33.88 / $56.23	Professional	26	$30.90	$33.88	$56.23
BCBS Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $112.20 / $165.96	Professional		$58.88	$112.20	$165.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $144.54 / $537.03	Professional		$79.43	$144.54	$537.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $37.15 / $83.18	Professional	26	$17.78	$37.15	$83.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $87.10 / $501.19	Professional	TC	$46.77	$87.10	$501.19
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $354.81 / $707.95	Professional		$114.82	$354.81	$707.95
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $89.13 / $380.19	Professional	26	$44.67	$89.13	$380.19
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $112.20 / $467.74	Professional	TC	$53.70	$112.20	$467.74
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 / $114.82 / $125.89	Professional		$114.82	$114.82	$125.89
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $57.54 / $60.26	Professional	26	$54.95	$57.54	$60.26
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $60.26 / $66.07	Professional	TC	$57.54	$60.26	$66.07
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 $97.72 / $151.36 / $489.78	Professional		$97.72	$151.36	$489.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $44.67 / $85.11	Professional	26	$18.62	$44.67	$85.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $97.72 / $426.58	Professional	TC	$56.23	$97.72	$426.58