Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.62 / $40.15 / $65.58	Facility	26	$27.62	$40.15	$65.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $97.68 / $133.27 / $493.07	Professional		$97.68	$133.27	$493.07
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.35 / $36.39 / $120.00	Professional	26	$23.35	$36.39	$120.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $74.04 / $86.57 / $153.68	Professional	TC	$74.04	$86.57	$153.68
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $83.12 / $108.83 / $118.73	Professional		$83.12	$108.83	$118.73
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $21.03 / $28.02 / $33.11	Professional	26	$21.03	$28.02	$33.11
BCBS Facility/Professional Professional Modifier Low / Median / High Price $27.20 / $97.88 / $194.87	Professional		$27.20	$97.88	$194.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $97.96 / $138.10 / $213.09	Professional		$97.96	$138.10	$213.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.75 / $35.34 / $52.86	Professional	26	$25.75	$35.34	$52.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $76.03 / $102.61 / $160.41	Professional	TC	$76.03	$102.61	$160.41
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $107.40 / $151.34 / $426.36	Professional		$107.40	$151.34	$426.36
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.98 / $38.63 / $164.04	Professional	26	$26.98	$38.63	$164.04
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $77.89 / $105.98 / $268.14	Professional	TC	$77.89	$105.98	$268.14
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 $114.74 / $117.42 / $126.93	Professional		$114.74	$117.42	$126.93
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $29.81 / $30.36 / $31.89	Professional	26	$29.81	$30.36	$31.89
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $84.38 / $87.61 / $95.04	Professional	TC	$84.38	$87.61	$95.04
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $33.36 / $132.79	Professional		$32.34	$33.36	$132.79
United Facility/Professional Professional Modifier Low / Median / High Price $99.72 / $141.38 / $228.26	Professional		$99.72	$141.38	$228.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.95 / $36.10 / $56.41	Professional	26	$25.95	$36.10	$56.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $70.93 / $103.92 / $148.59	Professional	TC	$70.93	$103.92	$148.59