Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.65 / $67.61 / $79.43	Facility	26	$43.65	$67.61	$79.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $173.78 / $616.60	Professional		$85.11	$173.78	$616.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $83.18 / $288.40	Professional	26	$42.66	$83.18	$288.40
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $169.82 / $288.40 / $616.60	Professional	50	$169.82	$288.40	$616.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $53.70 / $102.33	Professional	TC	$39.81	$53.70	$102.33
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $91.20 / $128.82	Professional		$79.43	$91.20	$128.82
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $43.65 / $58.88	Professional	26	$38.90	$43.65	$58.88
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $144.54 / $144.54 / $213.80	Professional	50	$144.54	$144.54	$213.80
BCBS Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $87.10 / $141.25	Professional		$48.98	$87.10	$141.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $125.89 / $194.98	Professional		$93.33	$125.89	$194.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $61.66 / $97.72	Professional	26	$46.77	$61.66	$97.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $63.10 / $100.00	Professional	TC	$46.77	$63.10	$100.00
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $154.88 / $467.74	Professional		$89.13	$154.88	$467.74
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $61.66 / $239.88	Professional	26	$41.69	$61.66	$239.88
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $66.07 / $162.18	Professional	TC	$43.65	$66.07	$162.18
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 $112.20 / $112.20 / $120.23	Professional		$112.20	$112.20	$120.23
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $53.70 / $57.54	Professional	26	$48.98	$53.70	$57.54
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $56.23 / $63.10	Professional	TC	$53.70	$56.23	$63.10
Molina Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $32.36 / $33.11	Professional		$31.62	$32.36	$33.11
United Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $120.23 / $181.97	Professional		$89.13	$120.23	$181.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $58.88 / $91.20	Professional	26	$43.65	$58.88	$91.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $58.88 / $93.33	Professional	TC	$43.65	$58.88	$93.33