Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.11 / $61.66 / $109.65	Facility	26	$33.11	$61.66	$109.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $154.88 / $363.08	Professional		$112.20	$154.88	$363.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $42.66 / $112.20	Professional	26	$30.20	$42.66	$112.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $117.49 / $223.87	Professional	TC	$91.20	$117.49	$223.87
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $120.23 / $120.23	Professional		$120.23	$120.23	$120.23
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $48.98 / $81.28	Professional	26	$33.11	$48.98	$81.28
BCBS Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $144.54 / $323.59	Professional		$45.71	$144.54	$323.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $194.98 / $295.12	Professional		$120.23	$194.98	$295.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $48.98 / $72.44	Professional	26	$30.20	$48.98	$72.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $144.54 / $218.78	Professional	TC	$91.20	$144.54	$218.78
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $281.84 / $645.65	Professional		$162.18	$281.84	$645.65
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $53.70 / $173.78	Professional	26	$38.02	$53.70	$173.78
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $158.49 / $346.74	Professional	TC	$112.20	$158.49	$346.74
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 $173.78 / $177.83 / $190.55	Professional		$173.78	$177.83	$190.55
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $43.65 / $46.77	Professional	26	$39.81	$43.65	$46.77
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $125.89 / $144.54	Professional	TC	$123.03	$125.89	$144.54
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 $134.90 / $173.78 / $269.15	Professional		$134.90	$173.78	$269.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $43.65 / $69.18	Professional	26	$34.67	$43.65	$69.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $131.83 / $204.17	Professional	TC	$100.00	$131.83	$204.17