Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.25 / $18.37 / $21.60	Facility	26	$12.25	$18.37	$21.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $75.54 / $115.56 / $321.27	Professional		$75.54	$115.56	$321.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.34 / $14.51 / $64.84	Professional	26	$11.34	$14.51	$64.84
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $35.28 / $43.01 / $229.68	Professional	52	$35.28	$43.01	$229.68
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $64.50 / $97.21 / $180.24	Professional	TC	$64.50	$97.21	$180.24
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $48.53 / $60.67 / $98.77	Professional		$48.53	$60.67	$98.77
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.49 / $12.01 / $14.90	Professional	26	$8.49	$12.01	$14.90
BCBS Facility/Professional Professional Modifier Low / Median / High Price $13.77 / $43.96 / $144.02	Professional		$13.77	$43.96	$144.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $79.66 / $115.37 / $178.87	Professional		$79.66	$115.37	$178.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.69 / $16.76 / $24.09	Professional	26	$11.69	$16.76	$24.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $69.09 / $99.85 / $151.87	Professional	TC	$69.09	$99.85	$151.87
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $86.46 / $120.00 / $177.00	Professional		$86.46	$120.00	$177.00
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.66 / $18.63 / $102.53	Professional	26	$13.66	$18.63	$102.53
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $55.55 / $93.38 / $149.40	Professional	TC	$55.55	$93.38	$149.40
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 $95.88 / $97.73 / $107.32	Professional		$95.88	$97.73	$107.32
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.74 / $14.94 / $16.14	Professional	26	$13.74	$14.94	$16.14
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $80.93 / $83.98 / $91.17	Professional	TC	$80.93	$83.98	$91.17
Molina Facility/Professional Professional Modifier Low / Median / High Price $16.89 / $32.34 / $112.27	Professional		$16.89	$32.34	$112.27
United Facility/Professional Professional Modifier Low / Median / High Price $86.62 / $121.94 / $185.41	Professional		$86.62	$121.94	$185.41
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.69 / $16.60 / $26.56	Professional	26	$11.69	$16.60	$26.56
United Facility/Professional Professional Modifier TC Low / Median / High Price $72.95 / $107.52 / $171.82	Professional	TC	$72.95	$107.52	$171.82