Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $68.62 / $105.92 / $161.27	Facility	26	$68.62	$105.92	$161.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $138.55 / $404.35 / $1,190.00	Professional		$138.55	$404.35	$1,190.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.15 / $120.06 / $342.40	Professional	26	$68.15	$120.06	$342.40
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $378.96 / $1,218.00 / $1,218.00	Professional	50	$378.96	$1,218.00	$1,218.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $104.87 / $141.08 / $237.50	Professional	52	$104.87	$141.08	$237.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $147.21 / $265.00 / $441.00	Professional	TC	$147.21	$265.00	$441.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $143.31 / $185.08 / $309.93	Professional		$143.31	$185.08	$309.93
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $43.99 / $60.68 / $90.41	Professional	26	$43.99	$60.68	$90.41
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $172.15 / $172.15 / $172.15	Professional	TC	$172.15	$172.15	$172.15
BCBS Facility/Professional Professional Modifier Low / Median / High Price $80.64 / $240.29 / $460.64	Professional		$80.64	$240.29	$460.64
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.71 / $85.71 / $85.71	Facility	26	$85.71	$85.71	$85.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $206.92 / $339.20 / $713.09	Professional		$206.92	$339.20	$713.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.50 / $90.08 / $135.91	Professional	26	$54.50	$90.08	$135.91
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $301.29 / $301.29 / $343.71	Professional	50	$301.29	$301.29	$343.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $140.97 / $234.95 / $572.83	Professional	TC	$140.97	$234.95	$572.83
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $233.80 / $362.88 / $2,300.58	Professional		$233.80	$362.88	$2,300.58
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $77.33 / $109.98 / $420.20	Professional	26	$77.33	$109.98	$420.20
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $161.94 / $254.02 / $1,944.08	Professional	TC	$161.94	$254.02	$1,944.08
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 $244.54 / $249.57 / $269.57	Professional		$244.54	$249.57	$269.57
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $77.73 / $79.43 / $83.77	Professional	26	$77.73	$79.43	$83.77
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $165.11 / $171.85 / $185.80	Professional	TC	$165.11	$171.85	$185.80
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $87.64 / $282.01	Professional		$32.34	$87.64	$282.01
United Facility/Professional Professional Modifier Low / Median / High Price $232.36 / $395.35 / $667.66	Professional		$232.36	$395.35	$667.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $65.37 / $84.44 / $135.31	Professional	26	$65.37	$84.44	$135.31
United Facility/Professional Professional Modifier TC Low / Median / High Price $161.60 / $272.74 / $565.88	Professional	TC	$161.60	$272.74	$565.88