Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.02 / $46.77 / $67.61	Facility	26	$38.02	$46.77	$67.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $269.15 / $758.58	Professional		$169.82	$269.15	$758.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $50.12 / $114.82	Professional	26	$34.67	$50.12	$114.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $186.21 / $371.54	Professional	TC	$138.04	$186.21	$371.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $154.88 / $234.42	Professional		$120.23	$154.88	$234.42
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $36.31 / $57.54	Professional	26	$28.18	$36.31	$57.54
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $107.15 / $257.04	Professional	TC	$89.13	$107.15	$257.04
BCBS Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $138.04 / $331.13	Professional		$42.66	$138.04	$331.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $269.15 / $446.68	Professional		$186.21	$269.15	$446.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $46.77 / $77.62	Professional	26	$32.36	$46.77	$77.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $218.78 / $371.54	Professional	TC	$151.36	$218.78	$371.54
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $316.23 / $851.14	Professional		$199.53	$316.23	$851.14
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $60.26 / $208.93	Professional	26	$40.74	$60.26	$208.93
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $223.87 / $602.56	Professional	TC	$158.49	$223.87	$602.56
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 $208.93 / $218.78 / $245.47	Professional		$208.93	$218.78	$245.47
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $44.67 / $50.12	Professional	26	$42.66	$44.67	$50.12
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $173.78 / $194.98	Professional	TC	$165.96	$173.78	$194.98
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 $190.55 / $257.04 / $398.11	Professional		$190.55	$257.04	$398.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $43.65 / $75.86	Professional	26	$31.62	$43.65	$75.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $218.78 / $338.84	Professional	TC	$151.36	$218.78	$338.84