Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.13 / $62.37 / $99.52	Facility	26	$37.13	$62.37	$99.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $134.06 / $224.00 / $667.50	Professional		$134.06	$224.00	$667.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.13 / $63.40 / $205.92	Professional	26	$37.13	$63.40	$205.92
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $96.93 / $154.80 / $250.91	Professional	TC	$96.93	$154.80	$250.91
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $102.97 / $114.02 / $149.55	Professional		$102.97	$114.02	$149.55
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $27.05 / $31.53 / $45.52	Professional	26	$27.05	$31.53	$45.52
BCBS Facility/Professional Professional Modifier Low / Median / High Price $42.07 / $137.41 / $279.02	Professional		$42.07	$137.41	$279.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $157.16 / $227.91 / $340.13	Professional		$157.16	$227.91	$340.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.64 / $57.77 / $92.17	Professional	26	$38.64	$57.77	$92.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $118.71 / $166.81 / $253.21	Professional	TC	$118.71	$166.81	$253.21
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $171.44 / $245.46 / $603.02	Professional		$171.44	$245.46	$603.02
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $41.72 / $60.69 / $271.70	Professional	26	$41.72	$60.69	$271.70
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $118.86 / $168.59 / $334.46	Professional	TC	$118.86	$168.59	$334.46
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 $185.73 / $189.96 / $205.87	Professional		$185.73	$189.96	$205.87
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $45.46 / $46.70 / $49.31	Professional	26	$45.46	$46.70	$49.31
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $139.04 / $144.47 / $156.55	Professional	TC	$139.04	$144.47	$156.55
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $51.58 / $200.97	Professional		$32.34	$51.58	$200.97
United Facility/Professional Professional Modifier Low / Median / High Price $166.00 / $239.22 / $381.19	Professional		$166.00	$239.22	$381.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.78 / $62.50 / $100.18	Professional	26	$40.78	$62.50	$100.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $123.79 / $179.59 / $270.93	Professional	TC	$123.79	$179.59	$270.93