Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.15 / $56.23 / $67.61	Facility	26	$37.15	$56.23	$67.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $234.42 / $537.03	Professional		$181.97	$234.42	$537.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $47.86 / $109.65	Professional	26	$29.51	$47.86	$109.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $177.83 / $346.74	Professional	TC	$144.54	$177.83	$346.74
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $147.91 / $323.59	Professional		$107.15	$147.91	$323.59
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $48.98 / $67.61	Professional	26	$27.54	$48.98	$67.61
BCBS Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $165.96 / $346.74	Professional		$42.66	$165.96	$346.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $275.42 / $457.09	Professional		$190.55	$275.42	$457.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $45.71 / $74.13	Professional	26	$26.30	$45.71	$74.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $223.87 / $398.11	Professional	TC	$154.88	$223.87	$398.11
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $323.59 / $645.65	Professional		$204.17	$323.59	$645.65
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $60.26 / $204.17	Professional	26	$38.90	$60.26	$204.17
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $257.04 / $512.86	Professional	TC	$169.82	$257.04	$512.86
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 $229.09 / $234.42 / $257.04	Professional		$229.09	$234.42	$257.04
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $46.77 / $50.12	Professional	26	$44.67	$46.77	$50.12
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $190.55 / $208.93	Professional	TC	$186.21	$190.55	$208.93
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 $194.98 / $263.03 / $407.38	Professional		$194.98	$263.03	$407.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $41.69 / $77.62	Professional	26	$25.12	$41.69	$77.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $223.87 / $346.74	Professional	TC	$158.49	$223.87	$346.74