Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.46 / $42.79 / $48.37	Facility	26	$27.46	$42.79	$48.37
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.21 / $109.72 / $189.03	Professional		$89.21	$109.72	$189.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.39 / $29.66 / $68.03	Professional	26	$25.39	$29.66	$68.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $62.82 / $76.03 / $133.91	Professional	TC	$62.82	$76.03	$133.91
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $65.17 / $85.22 / $136.22	Professional		$65.17	$85.22	$136.22
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $21.13 / $29.37 / $38.86	Professional	26	$21.13	$29.37	$38.86
BCBS Facility/Professional Professional Modifier Low / Median / High Price $36.03 / $105.55 / $234.97	Professional		$36.03	$105.55	$234.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $86.00 / $143.37 / $200.21	Professional		$86.00	$143.37	$200.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.34 / $38.93 / $56.60	Professional	26	$24.34	$38.93	$56.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $63.47 / $103.12 / $144.76	Professional	TC	$63.47	$103.12	$144.76
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $116.82 / $169.92 / $542.83	Professional		$116.82	$169.92	$542.83
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $31.67 / $46.06 / $193.15	Professional	26	$31.67	$46.06	$193.15
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $85.15 / $119.99 / $376.40	Professional	TC	$85.15	$119.99	$376.40
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 $124.74 / $127.32 / $138.06	Professional		$124.74	$127.32	$138.06
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $34.49 / $35.36 / $37.43	Professional	26	$34.49	$35.36	$37.43
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $89.36 / $92.83 / $100.63	Professional	TC	$89.36	$92.83	$100.63
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $39.15 / $144.43	Professional		$32.34	$39.15	$144.43
United Facility/Professional Professional Modifier Low / Median / High Price $101.39 / $128.34 / $196.25	Professional		$101.39	$128.34	$196.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.97 / $39.74 / $75.86	Professional	26	$28.97	$39.74	$75.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $70.38 / $95.27 / $138.65	Professional	TC	$70.38	$95.27	$138.65