Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.92 / $39.81 / $50.12	Facility	26	$26.92	$39.81	$50.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $70.79 / $257.04	Professional		$57.54	$70.79	$257.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $45.71 / $100.00	Professional	26	$25.70	$45.71	$100.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $36.31 / $79.43	Professional	TC	$29.51	$36.31	$79.43
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $57.54 / $58.88	Professional		$52.48	$57.54	$58.88
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $27.54 / $35.48	Professional	26	$23.44	$27.54	$35.48
BCBS Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $60.26 / $109.65	Professional		$30.20	$60.26	$109.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $87.10 / $177.83	Professional		$60.26	$87.10	$177.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $38.02 / $63.10	Professional	26	$27.54	$38.02	$63.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $48.98 / $93.33	Professional	TC	$32.36	$48.98	$93.33
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $131.83 / $316.23	Professional		$63.10	$131.83	$316.23
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $41.69 / $199.53	Professional	26	$27.54	$41.69	$199.53
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $61.66 / $269.15	Professional	TC	$34.67	$61.66	$269.15
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 $75.86 / $75.86 / $83.18	Professional		$75.86	$75.86	$83.18
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $33.88 / $35.48	Professional	26	$33.11	$33.88	$35.48
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $43.65 / $47.86	Professional	TC	$42.66	$43.65	$47.86
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $58.88	Professional		$32.36	$33.11	$58.88
United Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $72.44 / $114.82	Professional		$53.70	$72.44	$114.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $33.88 / $52.48	Professional	26	$25.70	$33.88	$52.48
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $37.15 / $57.54	Professional	TC	$27.54	$37.15	$57.54