Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.42 / $98.24 / $160.81	Facility	26	$67.42	$98.24	$160.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.18 / $114.36 / $206.83	Professional		$93.18	$114.36	$206.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.55 / $69.17 / $116.54	Professional	26	$59.55	$69.17	$116.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.51 / $47.82 / $83.48	Professional	TC	$30.51	$47.82	$83.48
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $109.41 / $109.41 / $120.67	Professional		$109.41	$109.41	$120.67
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $71.20 / $71.20 / $71.45	Professional	26	$71.20	$71.20	$71.45
BCBS Facility/Professional Professional Modifier Low / Median / High Price $66.03 / $115.56 / $212.75	Professional		$66.03	$115.56	$212.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $104.62 / $140.68 / $217.75	Professional		$104.62	$140.68	$217.75
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.34 / $86.67 / $136.59	Professional	26	$62.34	$86.67	$136.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $35.94 / $56.65 / $83.50	Professional	TC	$35.94	$56.65	$83.50
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $104.20 / $153.22 / $345.40	Professional		$104.20	$153.22	$345.40
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $59.50 / $84.30 / $180.21	Professional	26	$59.50	$84.30	$180.21
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $41.66 / $61.11 / $276.83	Professional	TC	$41.66	$61.11	$276.83
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 $125.27 / $126.50 / $135.46	Professional		$125.27	$126.50	$135.46
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $65.79 / $72.84 / $77.40	Professional	26	$65.79	$72.84	$77.40
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $51.58 / $53.66 / $58.06	Professional	TC	$51.58	$53.66	$58.06
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $55.83 / $141.71	Professional		$32.34	$55.83	$141.71
United Facility/Professional Professional Modifier Low / Median / High Price $85.10 / $121.69 / $195.15	Professional		$85.10	$121.69	$195.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $79.98 / $135.75	Professional	26	$57.54	$79.98	$135.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.14 / $41.69 / $70.50	Professional	TC	$27.14	$41.69	$70.50