Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $73.75 / $121.46 / $173.01	Facility	26	$73.75	$121.46	$173.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $252.89 / $475.00 / $963.49	Professional		$252.89	$475.00	$963.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $73.75 / $127.56 / $264.06	Professional	26	$73.75	$127.56	$264.06
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $118.33 / $161.09 / $277.37	Professional	52	$118.33	$161.09	$277.37
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $179.15 / $299.86 / $445.30	Professional	TC	$179.15	$299.86	$445.30
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $137.85 / $209.39 / $233.45	Professional		$137.85	$209.39	$233.45
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $51.30 / $58.69 / $102.24	Professional	26	$51.30	$58.69	$102.24
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $112.97 / $112.97 / $112.97	Professional	TC	$112.97	$112.97	$112.97
BCBS Facility/Professional Professional Modifier Low / Median / High Price $87.18 / $268.58 / $472.48	Professional		$87.18	$268.58	$472.48
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $91.38 / $91.38 / $91.38	Facility	26	$91.38	$91.38	$91.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $233.38 / $405.78 / $756.28	Professional		$233.38	$405.78	$756.28
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.45 / $97.19 / $146.59	Professional	26	$58.45	$97.19	$146.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $160.13 / $288.58 / $614.58	Professional	TC	$160.13	$288.58	$614.58
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $261.74 / $405.63 / $2,080.48	Professional		$261.74	$405.63	$2,080.48
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $83.59 / $118.78 / $639.04	Professional	26	$83.59	$118.78	$639.04
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $183.93 / $288.52 / $1,640.10	Professional	TC	$183.93	$288.52	$1,640.10
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 $273.33 / $279.55 / $301.33	Professional		$273.33	$279.55	$301.33
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $83.69 / $85.79 / $90.56	Professional	26	$83.69	$85.79	$90.56
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $187.54 / $195.86 / $210.77	Professional	TC	$187.54	$195.86	$210.77
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $94.74 / $315.23	Professional		$32.34	$94.74	$315.23
United Facility/Professional Professional Modifier Low / Median / High Price $268.25 / $457.49 / $716.77	Professional		$268.25	$457.49	$716.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $73.44 / $99.95 / $188.67	Professional	26	$73.44	$99.95	$188.67
United Facility/Professional Professional Modifier TC Low / Median / High Price $193.30 / $331.91 / $581.91	Professional	TC	$193.30	$331.91	$581.91