Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.70 / $77.62 / $186.21	Facility	26	$53.70	$77.62	$186.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $245.47 / $851.14	Professional		$123.03	$245.47	$851.14
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $58.88 / $190.55	Professional	26	$46.77	$58.88	$190.55
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $69.18 / $144.54 / $346.74	Professional	52	$69.18	$144.54	$346.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $128.82 / $371.54	Professional	TC	$79.43	$128.82	$371.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $104.71 / $151.36	Professional		$87.10	$104.71	$151.36
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $48.98 / $79.43	Professional	26	$38.02	$48.98	$79.43
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $79.43 / $123.03	Professional	TC	$61.66	$79.43	$123.03
BCBS Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $158.49 / $302.00	Professional		$64.57	$158.49	$302.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $63.10 / $63.10 / $63.10	Facility	26	$63.10	$63.10	$63.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $218.78 / $426.58	Professional		$134.90	$218.78	$426.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $69.18 / $102.33	Professional	26	$42.66	$69.18	$102.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $147.91 / $309.03	Professional	TC	$83.18	$147.91	$309.03
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $371.54 / $1,819.70	Professional		$154.88	$371.54	$1,819.70
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $104.71 / $467.74	Professional	26	$60.26	$104.71	$467.74
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $239.88 / $1,479.11	Professional	TC	$97.72	$239.88	$1,479.11
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 $162.18 / $162.18 / $177.83	Professional		$162.18	$162.18	$177.83
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $63.10 / $66.07	Professional	26	$61.66	$63.10	$66.07
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $102.33 / $109.65	Professional	TC	$97.72	$102.33	$109.65
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $33.11	Professional		$32.36	$33.11	$33.11
United Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $239.88 / $398.11	Professional		$151.36	$239.88	$398.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $66.07 / $107.15	Professional	26	$51.29	$66.07	$107.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $165.96 / $302.00	Professional	TC	$95.50	$165.96	$302.00