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 $210.52 / $475.00 / $1,355.00	Professional		$210.52	$475.00	$1,355.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.65 / $125.90 / $416.99	Professional	26	$70.65	$125.90	$416.99
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $99.20 / $135.33 / $237.50	Professional	52	$99.20	$135.33	$237.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $128.63 / $234.99 / $440.00	Professional	TC	$128.63	$234.99	$440.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $130.58 / $160.28 / $228.84	Professional		$130.58	$160.28	$228.84
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $50.43 / $59.53 / $95.38	Professional	26	$50.43	$59.53	$95.38
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $35.21 / $35.21 / $35.21	Professional	52	$35.21	$35.21	$35.21
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $86.30 / $146.94 / $149.80	Professional	TC	$86.30	$146.94	$149.80
BCBS Facility/Professional Professional Modifier Low / Median / High Price $88.41 / $226.45 / $478.93	Professional		$88.41	$226.45	$478.93
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $92.59 / $92.59 / $92.59	Facility	26	$92.59	$92.59	$92.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $195.00 / $324.79 / $786.58	Professional		$195.00	$324.79	$786.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.30 / $97.74 / $148.72	Professional	26	$59.30	$97.74	$148.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $122.48 / $207.77 / $595.94	Professional	TC	$122.48	$207.77	$595.94
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $220.04 / $345.40 / $2,284.48	Professional		$220.04	$345.40	$2,284.48
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $84.78 / $120.11 / $523.92	Professional	26	$84.78	$120.11	$523.92
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $140.68 / $220.68 / $1,714.30	Professional	TC	$140.68	$220.68	$1,714.30
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 $230.45 / $234.52 / $253.14	Professional		$230.45	$234.52	$253.14
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 $143.44 / $149.58 / $161.29	Professional	TC	$143.44	$149.58	$161.29
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $93.70 / $264.82	Professional		$32.34	$93.70	$264.82
United Facility/Professional Professional Modifier Low / Median / High Price $220.87 / $376.02 / $666.73	Professional		$220.87	$376.02	$666.73
United Facility/Professional Professional Modifier 26 Low / Median / High Price $71.89 / $92.13 / $144.76	Professional	26	$71.89	$92.13	$144.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $143.13 / $241.97 / $519.86	Professional	TC	$143.13	$241.97	$519.86