Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.61 / $104.71 / $194.98	Facility	26	$67.61	$104.71	$194.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $371.54 / $1,445.44	Professional		$107.15	$371.54	$1,445.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $120.23 / $363.08	Professional	26	$63.10	$120.23	$363.08
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $323.59 / $1,071.52 / $2,041.74	Professional	50	$323.59	$1,071.52	$2,041.74
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $61.66 / $151.36 / $524.81	Professional	52	$61.66	$151.36	$524.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $275.42 / $812.83	Professional	TC	$141.25	$275.42	$812.83
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $169.82 / $251.19	Professional		$138.04	$169.82	$251.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $52.48 / $91.20	Professional	26	$47.86	$52.48	$91.20
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $107.15 / $181.97	Professional	TC	$102.33	$107.15	$181.97
BCBS Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $239.88 / $457.09	Professional		$81.28	$239.88	$457.09
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $85.11 / $85.11	Facility	26	$85.11	$85.11	$85.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $371.54 / $724.44	Professional		$199.53	$371.54	$724.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $91.20 / $144.54	Professional	26	$54.95	$91.20	$144.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $257.04 / $602.56	Professional	TC	$141.25	$257.04	$602.56
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $588.84 / $2,398.83	Professional		$229.09	$588.84	$2,398.83
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $128.82 / $537.03	Professional	26	$75.86	$128.82	$537.03
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $446.68 / $1,949.84	Professional	TC	$165.96	$446.68	$1,949.84
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 $245.47 / $251.19 / $269.15	Professional		$245.47	$251.19	$269.15
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $79.43 / $83.18	Professional	26	$77.62	$79.43	$83.18
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $173.78 / $186.21	Professional	TC	$165.96	$173.78	$186.21
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 $223.87 / $380.19 / $707.95	Professional		$223.87	$380.19	$707.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $81.28 / $125.89	Professional	26	$61.66	$81.28	$125.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $263.03 / $588.84	Professional	TC	$151.36	$263.03	$588.84