Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.81 / $63.10 / $72.44	Facility	26	$39.81	$63.10	$72.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $95.50 / $208.93	Professional		$72.44	$95.50	$208.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $52.48 / $141.25	Professional	26	$38.90	$52.48	$141.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $44.67 / $81.28	Professional	TC	$26.30	$44.67	$81.28
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $93.33 / $93.33	Professional		$93.33	$93.33	$93.33
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $48.98 / $48.98	Professional	26	$48.98	$48.98	$48.98
BCBS Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $85.11 / $165.96	Professional		$44.67	$85.11	$165.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $107.15 / $165.96	Professional		$79.43	$107.15	$165.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $60.26 / $97.72	Professional	26	$42.66	$60.26	$97.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $50.12 / $77.62	Professional	TC	$29.51	$50.12	$77.62
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $131.83 / $257.04	Professional		$79.43	$131.83	$257.04
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $64.57 / $199.53	Professional	26	$40.74	$64.57	$199.53
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $56.23 / $107.15	Professional	TC	$35.48	$56.23	$107.15
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 $97.72 / $100.00 / $107.15	Professional		$97.72	$100.00	$107.15
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $50.12 / $52.48	Professional	26	$48.98	$50.12	$52.48
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $50.12 / $54.95	Professional	TC	$48.98	$50.12	$54.95
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $33.11	Professional		$32.36	$33.11	$33.11
United Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $93.33 / $141.25	Professional		$66.07	$93.33	$141.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $54.95 / $87.10	Professional	26	$39.81	$54.95	$87.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $37.15 / $60.26	Professional	TC	$23.99	$37.15	$60.26