Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.36 / $20.72 / $23.05	Facility	26	$12.36	$20.72	$23.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $84.17 / $102.28 / $171.64	Professional		$84.17	$102.28	$171.64
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.23 / $12.51 / $20.72	Professional	26	$11.23	$12.51	$20.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $72.93 / $89.92 / $132.08	Professional	TC	$72.93	$89.92	$132.08
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $12.36 / $12.36 / $12.36	Professional	26	$12.36	$12.36	$12.36
BCBS Facility/Professional Professional Modifier Low / Median / High Price $14.73 / $52.95 / $219.20	Professional		$14.73	$52.95	$219.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.97 / $14.97 / $14.97	Facility	26	$14.97	$14.97	$14.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $97.63 / $154.19 / $250.02	Professional		$97.63	$154.19	$250.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.88 / $15.88 / $23.74	Professional	26	$9.88	$15.88	$23.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $85.29 / $134.66 / $219.98	Professional	TC	$85.29	$134.66	$219.98
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $112.28 / $169.64 / $615.17	Professional		$112.28	$169.64	$615.17
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.66 / $20.60 / $75.27	Professional	26	$13.66	$20.60	$75.27
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $96.81 / $132.02 / $374.21	Professional	TC	$96.81	$132.02	$374.21
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 $116.38 / $120.65 / $129.72	Professional		$116.38	$120.65	$129.72
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.27 / $14.55 / $15.30	Professional	26	$14.27	$14.55	$15.30
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $97.25 / $101.83 / $114.41	Professional	TC	$97.25	$101.83	$114.41
Molina Facility/Professional Professional Modifier Low / Median / High Price $17.30 / $32.34 / $135.71	Professional		$17.30	$32.34	$135.71
United Facility/Professional Professional Modifier Low / Median / High Price $115.04 / $158.74 / $239.92	Professional		$115.04	$158.74	$239.92
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.93 / $15.40 / $23.56	Professional	26	$11.93	$15.40	$23.56
United Facility/Professional Professional Modifier TC Low / Median / High Price $100.87 / $145.01 / $212.40	Professional	TC	$100.87	$145.01	$212.40