Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $74.78 / $115.61 / $175.51	Facility	26	$74.78	$115.61	$175.51
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $32.63 / $60.75 / $120.01	Facility	53	$32.63	$60.75	$120.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $215.77 / $425.00 / $1,390.00	Professional		$215.77	$425.00	$1,390.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.75 / $120.95 / $408.00	Professional	26	$68.75	$120.95	$408.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $101.66 / $139.01 / $275.00	Professional	52	$101.66	$139.01	$275.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $140.99 / $245.19 / $433.05	Professional	TC	$140.99	$245.19	$433.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $134.09 / $158.07 / $199.99	Professional		$134.09	$158.07	$199.99
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $51.26 / $61.30 / $94.93	Professional	26	$51.26	$61.30	$94.93
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $90.24 / $156.63 / $156.63	Professional	TC	$90.24	$156.63	$156.63
BCBS Facility/Professional Professional Modifier Low / Median / High Price $88.00 / $232.47 / $534.49	Professional		$88.00	$232.47	$534.49
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $91.03 / $91.03 / $91.03	Facility	26	$91.03	$91.03	$91.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $200.19 / $332.94 / $749.07	Professional		$200.19	$332.94	$749.07
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.83 / $97.39 / $148.02	Professional	26	$58.83	$97.39	$148.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $128.04 / $215.23 / $590.60	Professional	TC	$128.04	$215.23	$590.60
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $226.01 / $350.02 / $2,025.01	Professional		$226.01	$350.02	$2,025.01
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $84.38 / $119.93 / $642.86	Professional	26	$84.38	$119.93	$642.86
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $147.07 / $230.70 / $1,672.32	Professional	TC	$147.07	$230.70	$1,672.32
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 $236.59 / $240.96 / $260.01	Professional		$236.59	$240.96	$260.01
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $84.54 / $86.62 / $91.42	Professional	26	$84.54	$86.62	$91.42
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $149.96 / $156.41 / $168.61	Professional	TC	$149.96	$156.41	$168.61
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $95.64 / $272.01	Professional		$32.34	$95.64	$272.01
United Facility/Professional Professional Modifier Low / Median / High Price $225.13 / $384.66 / $727.56	Professional		$225.13	$384.66	$727.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $72.27 / $91.38 / $143.47	Professional	26	$72.27	$91.38	$143.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $149.13 / $238.24 / $546.55	Professional	TC	$149.13	$238.24	$546.55