Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.62 / $46.77 / $107.15	Facility	26	$31.62	$46.77	$107.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $128.82 / $371.54	Professional		$70.79	$128.82	$371.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $56.23 / $158.49	Professional	26	$30.20	$56.23	$158.49
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $58.88 / $239.88 / $724.44	Professional	50	$58.88	$239.88	$724.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $74.13 / $141.25	Professional	TC	$56.23	$74.13	$141.25
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $79.43 / $169.82	Professional		$66.07	$79.43	$169.82
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $41.69 / $77.62	Professional	26	$26.30	$41.69	$77.62
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $100.00 / $125.89 / $251.19	Professional	50	$100.00	$125.89	$251.19
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $74.13 / $109.65	Professional	TC	$48.98	$74.13	$109.65
BCBS Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $109.65 / $229.09	Professional		$44.67	$109.65	$229.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $138.04 / $208.93	Professional		$85.11	$138.04	$208.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $48.98 / $74.13	Professional	26	$29.51	$48.98	$74.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $91.20 / $144.54	Professional	TC	$57.54	$91.20	$144.54
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $204.17 / $446.68	Professional		$112.20	$204.17	$446.68
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $52.48 / $199.53	Professional	26	$37.15	$52.48	$199.53
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $93.33 / $309.03	Professional	TC	$69.18	$93.33	$309.03
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 $120.23 / $123.03 / $131.83	Professional		$120.23	$123.03	$131.83
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $41.69 / $45.71	Professional	26	$38.90	$41.69	$45.71
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $77.62 / $87.10	Professional	TC	$74.13	$77.62	$87.10
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 / $125.89 / $186.21	Professional		$97.72	$125.89	$186.21
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $43.65 / $66.07	Professional	26	$33.11	$43.65	$66.07
United Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $81.28 / $123.03	Professional	TC	$63.10	$81.28	$123.03