Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $102.33 / $158.49 / $199.53	Facility	26	$102.33	$158.49	$199.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $512.86 / $1,348.96	Professional		$338.84	$512.86	$1,348.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $144.54 / $457.09	Professional	26	$100.00	$144.54	$457.09
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $151.36 / $302.00 / $346.74	Professional	52	$151.36	$302.00	$346.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $281.84 / $524.81	Professional	TC	$218.78	$281.84	$524.81
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $302.00 / $346.74	Professional		$245.47	$302.00	$346.74
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $93.33 / $112.20	Professional	26	$93.33	$93.33	$112.20
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $61.66 / $61.66 / $72.44	Professional	52	$61.66	$61.66	$72.44
BCBS Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $331.13 / $676.08	Professional		$123.03	$331.13	$676.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $467.74 / $741.31	Professional		$338.84	$467.74	$741.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $147.91 / $234.42	Professional	26	$109.65	$147.91	$234.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $331.13 / $478.63	Professional	TC	$234.42	$331.13	$478.63
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $524.81 / $1,258.93	Professional		$338.84	$524.81	$1,258.93
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $158.49 / $309.03	Professional	26	$109.65	$158.49	$309.03
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $338.84 / $691.83	Professional	TC	$234.42	$338.84	$691.83
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 $398.11 / $407.38 / $446.68	Professional		$398.11	$407.38	$446.68
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $123.03 / $138.04	Professional	26	$117.49	$123.03	$138.04
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $275.42 / $309.03	Professional	TC	$263.03	$275.42	$309.03
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 $323.59 / $426.58 / $707.95	Professional		$323.59	$426.58	$707.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $141.25 / $223.87	Professional	26	$109.65	$141.25	$223.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $281.84 / $501.19	Professional	TC	$208.93	$281.84	$501.19