Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.43 / $72.04 / $72.04	Facility	26	$45.43	$72.04	$72.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.56 / $137.46 / $219.17	Professional		$109.56	$137.46	$219.17
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.09 / $45.43 / $68.14	Professional	26	$40.09	$45.43	$68.14
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $68.23 / $85.21 / $126.68	Professional	TC	$68.23	$85.21	$126.68
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $90.23 / $98.73 / $123.85	Professional		$90.23	$98.73	$123.85
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $59.63 / $59.63 / $59.63	Professional	26	$59.63	$59.63	$59.63
BCBS Facility/Professional Professional Modifier Low / Median / High Price $48.99 / $111.19 / $180.69	Professional		$48.99	$111.19	$180.69
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.38 / $50.38 / $50.38	Facility	26	$50.38	$50.38	$50.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $119.24 / $169.06 / $295.45	Professional		$119.24	$169.06	$295.45
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.16 / $62.53 / $99.58	Professional	26	$45.16	$62.53	$99.58
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $73.64 / $108.09 / $200.07	Professional	TC	$73.64	$108.09	$200.07
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $118.21 / $170.94 / $506.31	Professional		$118.21	$170.94	$506.31
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $45.29 / $65.75 / $255.29	Professional	26	$45.29	$65.75	$255.29
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $59.08 / $99.60 / $259.17	Professional	TC	$59.08	$99.60	$259.17
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 $139.69 / $142.36 / $153.34	Professional		$139.69	$142.36	$153.34
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $53.29 / $54.35 / $57.42	Professional	26	$53.29	$54.35	$57.42
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $85.33 / $89.08 / $95.91	Professional	TC	$85.33	$89.08	$95.91
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $44.80 / $160.41	Professional		$32.34	$44.80	$160.41
United Facility/Professional Professional Modifier Low / Median / High Price $119.57 / $175.44 / $278.39	Professional		$119.57	$175.44	$278.39
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.40 / $60.00 / $99.14	Professional	26	$43.40	$60.00	$99.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $75.01 / $117.44 / $196.56	Professional	TC	$75.01	$117.44	$196.56