Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.69 / $64.57 / $141.25	Facility	26	$41.69	$64.57	$141.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $204.17 / $575.44	Professional		$107.15	$204.17	$575.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $83.18 / $208.93	Professional	26	$42.66	$83.18	$208.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $89.13 / $204.17	Professional	TC	$58.88	$89.13	$204.17
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $95.50 / $141.25	Professional		$79.43	$95.50	$141.25
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $45.71 / $67.61	Professional	26	$35.48	$45.71	$67.61
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $57.54 / $93.33	Professional	TC	$41.69	$57.54	$93.33
BCBS Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $123.03 / $263.03	Professional		$58.88	$123.03	$263.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $158.49 / $239.88	Professional		$100.00	$158.49	$239.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $66.07 / $93.33	Professional	26	$39.81	$66.07	$93.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $97.72 / $147.91	Professional	TC	$57.54	$97.72	$147.91
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $234.42 / $660.69	Professional		$128.82	$234.42	$660.69
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $93.33 / $263.03	Professional	26	$52.48	$93.33	$263.03
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $112.20 / $407.38	Professional	TC	$72.44	$112.20	$407.38
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 $138.04 / $141.25 / $151.36	Professional		$138.04	$141.25	$151.36
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $57.54 / $61.66	Professional	26	$57.54	$57.54	$61.66
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $83.18 / $91.20	Professional	TC	$79.43	$83.18	$91.20
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 $112.20 / $144.54 / $213.80	Professional		$112.20	$144.54	$213.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $57.54 / $91.20	Professional	26	$45.71	$57.54	$91.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $87.10 / $128.82	Professional	TC	$67.61	$87.10	$128.82