Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.20 / $53.52 / $107.04	Facility	26	$35.20	$53.52	$107.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $171.22 / $252.29 / $494.48	Professional		$171.22	$252.29	$494.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.32 / $52.82 / $123.07	Professional	26	$31.32	$52.82	$123.07
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $140.87 / $216.49 / $443.29	Professional	TC	$140.87	$216.49	$443.29
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $204.71 / $267.29 / $279.32	Professional		$204.71	$267.29	$279.32
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $27.36 / $39.90 / $45.60	Professional	26	$27.36	$39.90	$45.60
BCBS Facility/Professional Professional Modifier Low / Median / High Price $47.55 / $169.34 / $587.54	Professional		$47.55	$169.34	$587.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $187.50 / $342.14 / $499.84	Professional		$187.50	$342.14	$499.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.45 / $51.29 / $80.26	Professional	26	$34.45	$51.29	$80.26
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $155.93 / $298.08 / $431.60	Professional	TC	$155.93	$298.08	$431.60
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $240.24 / $388.69 / $840.36	Professional		$240.24	$388.69	$840.36
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $41.80 / $60.80 / $389.61	Professional	26	$41.80	$60.80	$389.61
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $204.15 / $321.02 / $637.72	Professional	TC	$204.15	$321.02	$637.72
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 $311.91 / $323.49 / $347.48	Professional		$311.91	$323.49	$347.48
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $45.96 / $46.51 / $49.40	Professional	26	$45.96	$46.51	$49.40
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $265.39 / $277.55 / $298.08	Professional	TC	$265.39	$277.55	$298.08
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $55.86 / $363.51	Professional		$32.34	$55.86	$363.51
United Facility/Professional Professional Modifier Low / Median / High Price $189.43 / $314.44 / $564.91	Professional		$189.43	$314.44	$564.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.54 / $45.94 / $72.16	Professional	26	$35.54	$45.94	$72.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $159.26 / $269.14 / $487.72	Professional	TC	$159.26	$269.14	$487.72