Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $74.78 / $116.12 / $175.51	Facility	26	$74.78	$116.12	$175.51
Aetna Facility/Professional Professional Modifier Low / Median / High Price $209.82 / $475.00 / $1,250.14	Professional		$209.82	$475.00	$1,250.14
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.68 / $130.00 / $416.99	Professional	26	$70.68	$130.00	$416.99
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $99.49 / $137.50 / $275.00	Professional	52	$99.49	$137.50	$275.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $130.81 / $234.99 / $440.00	Professional	TC	$130.81	$234.99	$440.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $130.15 / $151.90 / $196.49	Professional		$130.15	$151.90	$196.49
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $51.48 / $59.53 / $95.38	Professional	26	$51.48	$59.53	$95.38
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $105.27 / $105.27 / $105.27	Professional	TC	$105.27	$105.27	$105.27
BCBS Facility/Professional Professional Modifier Low / Median / High Price $93.52 / $233.88 / $714.40	Professional		$93.52	$233.88	$714.40
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $99.49 / $99.49 / $99.49	Facility	26	$99.49	$99.49	$99.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $194.35 / $323.70 / $738.29	Professional		$194.35	$323.70	$738.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.60 / $98.90 / $154.50	Professional	26	$59.60	$98.90	$154.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $121.82 / $207.23 / $572.28	Professional	TC	$121.82	$207.23	$572.28
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $219.30 / $345.40 / $2,297.69	Professional		$219.30	$345.40	$2,297.69
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $84.78 / $120.47 / $532.12	Professional	26	$84.78	$120.47	$532.12
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $139.93 / $219.50 / $1,577.31	Professional	TC	$139.93	$219.50	$1,577.31
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 $229.68 / $233.71 / $252.28	Professional		$229.68	$233.71	$252.28
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $84.94 / $87.01 / $91.85	Professional	26	$84.94	$87.01	$91.85
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $142.68 / $148.77 / $160.43	Professional	TC	$142.68	$148.77	$160.43
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $96.08 / $263.92	Professional		$32.34	$96.08	$263.92
United Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $375.44 / $672.42	Professional		$218.78	$375.44	$672.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $75.04 / $94.59 / $165.41	Professional	26	$75.04	$94.59	$165.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $142.78 / $241.39 / $509.24	Professional	TC	$142.78	$241.39	$509.24