Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.70 / $89.13 / $95.50	Facility	26	$53.70	$89.13	$95.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $117.49 / $309.03	Professional		$83.18	$117.49	$309.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $74.13 / $186.21	Professional	26	$52.48	$74.13	$186.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $44.67 / $81.28	Professional	TC	$27.54	$44.67	$81.28
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $104.71 / $120.23	Professional		$87.10	$104.71	$120.23
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $58.88 / $72.44	Professional	26	$47.86	$58.88	$72.44
BCBS Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $107.15 / $194.98	Professional		$60.26	$107.15	$194.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $125.89 / $194.98	Professional		$93.33	$125.89	$194.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $77.62 / $123.03	Professional	26	$54.95	$77.62	$123.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $50.12 / $77.62	Professional	TC	$30.20	$50.12	$77.62
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $151.36 / $436.52	Professional		$93.33	$151.36	$436.52
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $74.13 / $199.53	Professional	26	$51.29	$74.13	$199.53
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $52.48 / $141.25	Professional	TC	$37.15	$52.48	$141.25
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 $114.82 / $117.49 / $125.89	Professional		$114.82	$117.49	$125.89
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $67.61 / $70.79	Professional	26	$60.26	$67.61	$70.79
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $47.86 / $53.70	Professional	TC	$45.71	$47.86	$53.70
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 $79.43 / $109.65 / $169.82	Professional		$79.43	$109.65	$169.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $70.79 / $114.82	Professional	26	$53.70	$70.79	$114.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $37.15 / $58.88	Professional	TC	$23.99	$37.15	$58.88