Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.21 / $63.81 / $86.58	Facility	26	$40.21	$63.81	$86.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $180.04 / $204.65 / $378.08	Professional		$180.04	$204.65	$378.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.61 / $40.21 / $75.91	Professional	26	$23.61	$40.21	$75.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $144.59 / $169.96 / $299.61	Professional	TC	$144.59	$169.96	$299.61
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $117.01 / $154.61 / $218.20	Professional		$117.01	$154.61	$218.20
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $27.20 / $32.38 / $41.32	Professional	26	$27.20	$32.38	$41.32
BCBS Facility/Professional Professional Modifier Low / Median / High Price $43.14 / $139.16 / $347.61	Professional		$43.14	$139.16	$347.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $190.21 / $267.79 / $414.19	Professional		$190.21	$267.79	$414.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.58 / $47.29 / $72.73	Professional	26	$26.58	$47.29	$72.73
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $156.04 / $223.24 / $347.16	Professional	TC	$156.04	$223.24	$347.16
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $208.29 / $299.04 / $643.46	Professional		$208.29	$299.04	$643.46
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $57.48 / $177.22	Professional	26	$38.90	$57.48	$177.22
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $170.53 / $240.75 / $466.24	Professional	TC	$170.53	$240.75	$466.24
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 $231.40 / $235.98 / $257.87	Professional		$231.40	$235.98	$257.87
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $44.68 / $47.29 / $50.57	Professional	26	$44.68	$47.29	$50.57
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $184.11 / $191.31 / $207.30	Professional	TC	$184.11	$191.31	$207.30
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $52.90 / $269.77	Professional		$32.34	$52.90	$269.77
United Facility/Professional Professional Modifier Low / Median / High Price $202.15 / $281.51 / $437.09	Professional		$202.15	$281.51	$437.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $45.27 / $85.69	Professional	26	$26.30	$45.27	$85.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $167.65 / $241.89 / $395.86	Professional	TC	$167.65	$241.89	$395.86