Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.96 / $46.70 / $61.71	Facility	26	$31.96	$46.70	$61.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.47 / $110.31 / $209.36	Professional		$81.47	$110.31	$209.36
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.99 / $36.20 / $94.90	Professional	26	$30.99	$36.20	$94.90
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $63.34 / $259.31 / $749.61	Professional	50	$63.34	$259.31	$749.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $57.05 / $69.59 / $117.14	Professional	TC	$57.05	$69.59	$117.14
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $61.00 / $78.40 / $103.58	Professional		$61.00	$78.40	$103.58
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.56 / $38.75 / $67.31	Professional	26	$25.56	$38.75	$67.31
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $100.08 / $114.37 / $148.77	Professional	50	$100.08	$114.37	$148.77
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $74.09 / $74.09 / $95.92	Professional	TC	$74.09	$74.09	$95.92
BCBS Facility/Professional Professional Modifier Low / Median / High Price $44.21 / $116.65 / $228.00	Professional		$44.21	$116.65	$228.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.29 / $138.36 / $201.80	Professional		$87.29	$138.36	$201.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.07 / $47.69 / $69.95	Professional	26	$30.07	$47.69	$69.95
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $138.68 / $138.68 / $138.68	Professional	50	$138.68	$138.68	$138.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $57.39 / $90.67 / $131.85	Professional	TC	$57.39	$90.67	$131.85
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $112.74 / $163.98 / $379.28	Professional		$112.74	$163.98	$379.28
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.70 / $52.98 / $137.80	Professional	26	$36.70	$52.98	$137.80
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $95.58 / $200.61	Professional	TC	$67.61	$95.58	$200.61
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 $121.04 / $123.15 / $133.24	Professional		$121.04	$123.15	$133.24
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $39.03 / $42.12 / $45.92	Professional	26	$39.03	$42.12	$45.92
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $74.20 / $77.66 / $87.31	Professional	TC	$74.20	$77.66	$87.31
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $48.04 / $139.38	Professional		$32.34	$48.04	$139.38
United Facility/Professional Professional Modifier Low / Median / High Price $98.50 / $128.47 / $194.18	Professional		$98.50	$128.47	$194.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.45 / $44.09 / $65.81	Professional	26	$33.45	$44.09	$65.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $67.20 / $86.18 / $124.97	Professional	TC	$67.20	$86.18	$124.97