Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $115.26 / $181.01 / $270.82	Facility	26	$115.26	$181.01	$270.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $351.74 / $475.00 / $1,320.50	Professional		$351.74	$475.00	$1,320.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $115.26 / $183.23 / $596.60	Professional	26	$115.26	$183.23	$596.60
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $163.81 / $204.93 / $302.74	Professional	52	$163.81	$204.93	$302.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $228.22 / $335.00 / $462.42	Professional	TC	$228.22	$335.00	$462.42
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $224.90 / $267.52 / $381.03	Professional		$224.90	$267.52	$381.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $78.43 / $108.93 / $148.78	Professional	26	$78.43	$108.93	$148.78
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $149.74 / $203.93 / $296.76	Professional	TC	$149.74	$203.93	$296.76
BCBS Facility/Professional Professional Modifier Low / Median / High Price $137.91 / $377.34 / $913.21	Professional		$137.91	$377.34	$913.21
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $146.01 / $146.01 / $146.01	Facility	26	$146.01	$146.01	$146.01
Cigna Facility/Professional Professional Modifier Low / Median / High Price $324.93 / $525.00 / $1,399.95	Professional		$324.93	$525.00	$1,399.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $92.04 / $154.30 / $229.81	Professional	26	$92.04	$154.30	$229.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $212.37 / $361.60 / $1,120.83	Professional	TC	$212.37	$361.60	$1,120.83
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $357.80 / $569.22 / $3,820.89	Professional		$357.80	$569.22	$3,820.89
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $131.11 / $187.33 / $806.50	Professional	26	$131.11	$187.33	$806.50
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $243.93 / $382.64 / $2,686.76	Professional	TC	$243.93	$382.64	$2,686.76
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 $384.01 / $390.68 / $422.85	Professional		$384.01	$390.68	$422.85
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $131.11 / $135.29 / $143.27	Professional	26	$131.11	$135.29	$143.27
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $248.72 / $259.58 / $279.58	Professional	TC	$248.72	$259.58	$279.58
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $149.88 / $442.37	Professional		$32.34	$149.88	$442.37
United Facility/Professional Professional Modifier Low / Median / High Price $367.32 / $617.34 / $1,195.85	Professional		$367.32	$617.34	$1,195.85
United Facility/Professional Professional Modifier 26 Low / Median / High Price $111.47 / $145.65 / $253.91	Professional	26	$111.47	$145.65	$253.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $250.66 / $421.40 / $902.22	Professional	TC	$250.66	$421.40	$902.22