Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.53 / $82.98 / $100.72	Facility	26	$54.53	$82.98	$100.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $133.88 / $226.08 / $687.35	Professional		$133.88	$226.08	$687.35
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.24 / $66.06 / $228.65	Professional	26	$46.24	$66.06	$228.65
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $66.72 / $81.52 / $133.28	Professional	52	$66.72	$81.52	$133.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $82.42 / $156.07 / $278.57	Professional	TC	$82.42	$156.07	$278.57
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $94.28 / $120.10 / $159.46	Professional		$94.28	$120.10	$159.46
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $37.46 / $48.62 / $71.63	Professional	26	$37.46	$48.62	$71.63
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $65.77 / $87.73 / $101.67	Professional	TC	$65.77	$87.73	$101.67
BCBS Facility/Professional Professional Modifier Low / Median / High Price $64.26 / $157.71 / $302.33	Professional		$64.26	$157.71	$302.33
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.76 / $62.76 / $62.76	Facility	26	$62.76	$62.76	$62.76
Cigna Facility/Professional Professional Modifier Low / Median / High Price $137.04 / $216.62 / $426.90	Professional		$137.04	$216.62	$426.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.79 / $69.31 / $104.80	Professional	26	$42.79	$69.31	$104.80
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $83.01 / $140.00 / $303.75	Professional	TC	$83.01	$140.00	$303.75
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $153.33 / $243.70 / $1,315.07	Professional		$153.33	$243.70	$1,315.07
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $61.62 / $87.61 / $339.04	Professional	26	$61.62	$87.61	$339.04
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $95.36 / $149.58 / $861.26	Professional	TC	$95.36	$149.58	$861.26
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 $160.50 / $163.36 / $176.01	Professional		$160.50	$163.36	$176.01
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $61.80 / $63.27 / $66.76	Professional	26	$61.80	$63.27	$66.76
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $97.23 / $101.56 / $109.25	Professional	TC	$97.23	$101.56	$109.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $69.84 / $184.13	Professional		$32.34	$69.84	$184.13
United Facility/Professional Professional Modifier Low / Median / High Price $159.03 / $244.75 / $399.61	Professional		$159.03	$244.75	$399.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.61 / $68.06 / $110.25	Professional	26	$53.61	$68.06	$110.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $100.40 / $165.50 / $283.86	Professional	TC	$100.40	$165.50	$283.86