Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.78 / $38.97 / $42.62	Facility	26	$25.78	$38.97	$42.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $147.13 / $209.81 / $498.02	Professional		$147.13	$209.81	$498.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.49 / $25.95 / $58.00	Professional	26	$22.49	$25.95	$58.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $123.19 / $175.98 / $338.54	Professional	TC	$123.19	$175.98	$338.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $135.47 / $135.47 / $150.53	Professional		$135.47	$135.47	$150.53
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $17.14 / $17.82 / $25.72	Professional	26	$17.14	$17.82	$25.72
BCBS Facility/Professional Professional Modifier Low / Median / High Price $27.19 / $87.34 / $279.95	Professional		$27.19	$87.34	$279.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $154.60 / $220.43 / $344.39	Professional		$154.60	$220.43	$344.39
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.58 / $33.18 / $50.70	Professional	26	$23.58	$33.18	$50.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $133.78 / $189.90 / $293.17	Professional	TC	$133.78	$189.90	$293.17
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $163.69 / $240.24 / $641.69	Professional		$163.69	$240.24	$641.69
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.96 / $36.94 / $124.45	Professional	26	$26.96	$36.94	$124.45
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $138.46 / $201.27 / $517.24	Professional	TC	$138.46	$201.27	$517.24
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 $186.36 / $190.75 / $208.21	Professional		$186.36	$190.75	$208.21
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $27.76 / $29.68 / $31.86	Professional	26	$27.76	$29.68	$31.86
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $156.68 / $162.99 / $176.33	Professional	TC	$156.68	$162.99	$176.33
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $33.33 / $217.82	Professional		$32.34	$33.33	$217.82
United Facility/Professional Professional Modifier Low / Median / High Price $166.13 / $238.42 / $377.89	Professional		$166.13	$238.42	$377.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.71 / $32.43 / $53.12	Professional	26	$23.71	$32.43	$53.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $140.22 / $203.83 / $308.33	Professional	TC	$140.22	$203.83	$308.33