Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.18 / $53.70 / $95.50	Facility	26	$28.18	$53.70	$95.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $181.97 / $426.58	Professional		$112.20	$181.97	$426.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $50.12 / $138.04	Professional	26	$28.18	$50.12	$138.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $107.15 / $213.80	Professional	TC	$75.86	$107.15	$213.80
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $141.25 / $263.03	Professional		$93.33	$141.25	$263.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $30.20 / $52.48	Professional	26	$23.99	$30.20	$52.48
BCBS Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $208.93 / $436.52	Professional		$39.81	$208.93	$436.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $190.55 / $338.84	Professional		$107.15	$190.55	$338.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $44.67 / $67.61	Professional	26	$28.18	$44.67	$67.61
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $158.49 / $288.40	Professional	TC	$72.44	$158.49	$288.40
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $316.23 / $602.56	Professional		$186.21	$316.23	$602.56
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $58.88 / $457.09	Professional	26	$36.31	$58.88	$457.09
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $13.49 / $218.78 / $446.68	Professional	TC	$13.49	$218.78	$446.68
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 $229.09 / $239.88 / $257.04	Professional		$229.09	$239.88	$257.04
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $39.81 / $41.69	Professional	26	$38.90	$39.81	$41.69
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $199.53 / $213.80	Professional	TC	$190.55	$199.53	$213.80
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 $109.65 / $165.96 / $269.15	Professional		$109.65	$165.96	$269.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $39.81 / $60.26	Professional	26	$30.90	$39.81	$60.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $131.83 / $208.93	Professional	TC	$72.44	$131.83	$208.93