Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.78 / $57.30 / $73.47	Facility	26	$40.78	$57.30	$73.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $47.87 / $103.70 / $321.47	Professional		$47.87	$103.70	$321.47
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.78 / $40.78 / $103.76	Professional	26	$24.78	$40.78	$103.76
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $9.32 / $24.53 / $129.54	Professional	TC	$9.32	$24.53	$129.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $32.67 / $43.10 / $52.71	Professional		$32.67	$43.10	$52.71
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $20.05 / $32.57 / $58.29	Professional	26	$20.05	$32.57	$58.29
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $7.82 / $7.82 / $7.82	Professional	TC	$7.82	$7.82	$7.82
BCBS Facility/Professional Professional Modifier Low / Median / High Price $54.03 / $67.69 / $123.71	Professional		$54.03	$67.69	$123.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $53.05 / $88.16 / $195.61	Professional		$53.05	$88.16	$195.61
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.54 / $50.35 / $76.86	Professional	26	$31.54	$50.35	$76.86
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $115.21 / $115.21 / $115.21	Professional	50	$115.21	$115.21	$115.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $10.55 / $20.39 / $143.91	Professional	TC	$10.55	$20.39	$143.91
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $59.50 / $88.41 / $343.47	Professional		$59.50	$88.41	$343.47
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $47.50 / $67.90 / $209.65	Professional	26	$47.50	$67.90	$209.65
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $12.00 / $17.26 / $184.70	Professional	TC	$12.00	$17.26	$184.70
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 $64.70 / $65.68 / $70.31	Professional		$64.70	$65.68	$70.31
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.09 / $53.21 / $56.13	Professional	26	$52.09	$53.21	$56.13
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $12.47 / $12.61 / $14.18	Professional	TC	$12.47	$12.61	$14.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $14.84 / $32.34 / $73.56	Professional		$14.84	$32.34	$73.56
United Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $121.41 / $179.76	Professional		$74.13	$121.41	$179.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.52 / $41.76 / $85.00	Professional	26	$30.52	$41.76	$85.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $41.95 / $79.27 / $121.76	Professional	TC	$41.95	$79.27	$121.76