Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.53 / $26.69 / $31.65	Facility	26	$16.53	$26.69	$31.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $84.63 / $104.50 / $166.58	Professional		$84.63	$104.50	$166.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.03 / $21.28 / $71.00	Professional	26	$16.03	$21.28	$71.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $68.59 / $87.32 / $137.05	Professional	TC	$68.59	$87.32	$137.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $72.06 / $72.20 / $78.98	Professional		$72.06	$72.20	$78.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $13.20 / $20.30 / $25.60	Professional	26	$13.20	$20.30	$25.60
BCBS Facility/Professional Professional Modifier Low / Median / High Price $23.73 / $96.45 / $214.72	Professional		$23.73	$96.45	$214.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $78.34 / $127.02 / $190.07	Professional		$78.34	$127.02	$190.07
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.53 / $25.34 / $38.17	Professional	26	$15.53	$25.34	$38.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $63.35 / $105.10 / $160.34	Professional	TC	$63.35	$105.10	$160.34
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $109.61 / $160.13 / $352.19	Professional		$109.61	$160.13	$352.19
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $21.57 / $31.72 / $126.66	Professional	26	$21.57	$31.72	$126.66
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $86.63 / $118.13 / $235.23	Professional	TC	$86.63	$118.13	$235.23
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 $114.00 / $116.48 / $127.02	Professional		$114.00	$116.48	$127.02
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $21.36 / $22.91 / $24.65	Professional	26	$21.36	$22.91	$24.65
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $87.02 / $91.09 / $102.38	Professional	TC	$87.02	$91.09	$102.38
Molina Facility/Professional Professional Modifier Low / Median / High Price $25.79 / $32.34 / $132.88	Professional		$25.79	$32.34	$132.88
United Facility/Professional Professional Modifier Low / Median / High Price $89.52 / $120.40 / $189.11	Professional		$89.52	$120.40	$189.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $18.17 / $23.45 / $36.52	Professional	26	$18.17	$23.45	$36.52
United Facility/Professional Professional Modifier TC Low / Median / High Price $70.80 / $101.00 / $151.66	Professional	TC	$70.80	$101.00	$151.66