Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $90.21 / $150.72 / $211.43	Facility	26	$90.21	$150.72	$211.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $287.86 / $472.17 / $661.00	Professional		$287.86	$472.17	$661.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.23 / $140.00 / $199.08	Professional	26	$89.23	$140.00	$199.08
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $138.85 / $180.23 / $264.29	Professional	52	$138.85	$180.23	$264.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $198.63 / $327.78 / $440.00	Professional	TC	$198.63	$327.78	$440.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $163.12 / $163.76 / $276.93	Professional		$163.12	$163.76	$276.93
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $62.57 / $71.40 / $109.73	Professional	26	$62.57	$71.40	$109.73
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $132.58 / $180.59 / $180.59	Professional	TC	$132.58	$180.59	$180.59
BCBS Facility/Professional Professional Modifier Low / Median / High Price $106.01 / $319.12 / $611.75	Professional		$106.01	$319.12	$611.75
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $110.82 / $110.82 / $110.82	Facility	26	$110.82	$110.82	$110.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $274.80 / $455.02 / $904.38	Professional		$274.80	$455.02	$904.38
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $71.15 / $117.18 / $176.07	Professional	26	$71.15	$117.18	$176.07
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $188.13 / $318.08 / $718.25	Professional	TC	$188.13	$318.08	$718.25
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $310.85 / $481.74 / $2,299.96	Professional		$310.85	$481.74	$2,299.96
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $101.65 / $144.59 / $777.50	Professional	26	$101.65	$144.59	$777.50
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $216.10 / $338.98 / $1,780.26	Professional	TC	$216.10	$338.98	$1,780.26
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 $324.77 / $331.92 / $357.86	Professional		$324.77	$331.92	$357.86
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $102.12 / $104.43 / $110.12	Professional	26	$102.12	$104.43	$110.12
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $220.34 / $229.80 / $247.74	Professional	TC	$220.34	$229.80	$247.74
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $115.21 / $374.38	Professional		$32.34	$115.21	$374.38
United Facility/Professional Professional Modifier Low / Median / High Price $313.62 / $532.66 / $834.69	Professional		$313.62	$532.66	$834.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $86.64 / $109.57 / $169.92	Professional	26	$86.64	$109.57	$169.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $220.00 / $338.80 / $642.33	Professional	TC	$220.00	$338.80	$642.33