Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.65 / $70.79 / $141.25	Facility	26	$43.65	$70.79	$141.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $234.42 / $575.44	Professional		$123.03	$234.42	$575.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $83.18 / $204.17	Professional	26	$42.66	$83.18	$204.17
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $109.65 / $218.78	Professional	TC	$74.13	$109.65	$218.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $112.20 / $181.97	Professional		$87.10	$112.20	$181.97
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $47.86 / $64.57	Professional	26	$35.48	$47.86	$64.57
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $70.79 / $117.49	Professional	TC	$50.12	$70.79	$117.49
BCBS Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $131.83 / $302.00	Professional		$58.88	$131.83	$302.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $181.97 / $275.42	Professional		$114.82	$181.97	$275.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $66.07 / $100.00	Professional	26	$41.69	$66.07	$100.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $120.23 / $186.21	Professional	TC	$75.86	$120.23	$186.21
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $245.47 / $758.58	Professional		$147.91	$245.47	$758.58
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $85.11 / $302.00	Professional	26	$52.48	$85.11	$302.00
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $144.54 / $457.09	Professional	TC	$95.50	$144.54	$457.09
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 $158.49 / $162.18 / $173.78	Professional		$158.49	$162.18	$173.78
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $58.88 / $61.66	Professional	26	$57.54	$58.88	$61.66
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $104.71 / $112.20	Professional	TC	$100.00	$104.71	$112.20
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 $128.82 / $162.18 / $239.88	Professional		$128.82	$162.18	$239.88
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 $83.18 / $107.15 / $154.88	Professional	TC	$83.18	$107.15	$154.88