Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.89 / $64.89 / $79.65	Facility	26	$42.89	$64.89	$79.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $135.00 / $226.80 / $606.79	Professional		$135.00	$226.80	$606.79
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.45 / $57.18 / $213.36	Professional	26	$40.45	$57.18	$213.36
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $64.14 / $75.62 / $126.60	Professional	52	$64.14	$75.62	$126.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $91.73 / $153.66 / $291.63	Professional	TC	$91.73	$153.66	$291.63
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $63.02 / $113.50 / $153.08	Professional		$63.02	$113.50	$153.08
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $29.44 / $34.75 / $55.20	Professional	26	$29.44	$34.75	$55.20
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $108.11 / $108.11 / $108.11	Professional	TC	$108.11	$108.11	$108.11
BCBS Facility/Professional Professional Modifier Low / Median / High Price $51.17 / $151.03 / $275.04	Professional		$51.17	$151.03	$275.04
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.63 / $69.63 / $69.63	Facility	26	$69.63	$69.63	$69.63
Cigna Facility/Professional Professional Modifier Low / Median / High Price $128.76 / $203.15 / $386.87	Professional		$128.76	$203.15	$386.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.18 / $61.33 / $92.08	Professional	26	$35.18	$61.33	$92.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $87.46 / $140.00 / $274.64	Professional	TC	$87.46	$140.00	$274.64
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $147.19 / $234.40 / $1,015.09	Professional		$147.19	$234.40	$1,015.09
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $49.07 / $76.65 / $373.21	Professional	26	$49.07	$76.65	$373.21
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $98.27 / $149.19 / $641.53	Professional	TC	$98.27	$149.19	$641.53
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 $153.69 / $157.16 / $169.29	Professional		$153.69	$157.16	$169.29
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $49.18 / $50.34 / $53.16	Professional	26	$49.18	$50.34	$53.16
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $103.36 / $107.99 / $116.14	Professional	TC	$103.36	$107.99	$116.14
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $55.61 / $177.10	Professional		$32.34	$55.61	$177.10
United Facility/Professional Professional Modifier Low / Median / High Price $140.53 / $225.52 / $352.98	Professional		$140.53	$225.52	$352.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.03 / $58.57 / $90.37	Professional	26	$44.03	$58.57	$90.37
United Facility/Professional Professional Modifier TC Low / Median / High Price $96.47 / $159.02 / $272.43	Professional	TC	$96.47	$159.02	$272.43