Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $74.13 / $112.20 / $213.80	Facility	26	$74.13	$112.20	$213.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $467.74 / $1,445.44	Professional		$208.93	$467.74	$1,445.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $120.23 / $338.84	Professional	26	$67.61	$120.23	$338.84
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $134.90 / $316.23 / $562.34	Professional	52	$134.90	$316.23	$562.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $239.88 / $630.96	Professional	TC	$120.23	$239.88	$630.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $147.91 / $234.42	Professional		$128.82	$147.91	$234.42
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $64.57 / $102.33	Professional	26	$52.48	$64.57	$102.33
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $93.33 / $147.91	Professional	TC	$81.28	$93.33	$147.91
BCBS Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $234.42 / $758.58	Professional		$93.33	$234.42	$758.58
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	26	$100.00	$100.00	$100.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $363.08 / $758.58	Professional		$194.98	$363.08	$758.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $100.00 / $154.88	Professional	26	$61.66	$100.00	$154.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $218.78 / $588.84	Professional	TC	$123.03	$218.78	$588.84
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $616.60 / $2,454.71	Professional		$213.80	$616.60	$2,454.71
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $141.25 / $537.03	Professional	26	$83.18	$141.25	$537.03
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $512.86 / $1,862.09	Professional	TC	$141.25	$512.86	$1,862.09
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 $229.09 / $234.42 / $251.19	Professional		$229.09	$234.42	$251.19
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $87.10 / $91.20	Professional	26	$85.11	$87.10	$91.20
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $147.91 / $162.18	Professional	TC	$141.25	$147.91	$162.18
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 $208.93 / $371.54 / $707.95	Professional		$208.93	$371.54	$707.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $91.20 / $138.04	Professional	26	$69.18	$91.20	$138.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $229.09 / $562.34	Professional	TC	$134.90	$229.09	$562.34