Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.61 / $109.65 / $194.98	Facility	26	$67.61	$109.65	$194.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $371.54 / $1,348.96	Professional		$85.11	$371.54	$1,348.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $125.89 / $457.09	Professional	26	$63.10	$125.89	$457.09
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $125.89 / $478.63 / $1,778.28	Professional	50	$125.89	$478.63	$1,778.28
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $31.62 / $288.40 / $501.19	Professional	52	$31.62	$288.40	$501.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $281.84 / $851.14	Professional	TC	$141.25	$281.84	$851.14
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $173.78 / $288.40	Professional		$134.90	$173.78	$288.40
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $58.88 / $102.33	Professional	26	$47.86	$58.88	$102.33
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $125.89 / $169.82	Professional	TC	$102.33	$125.89	$169.82
BCBS Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $239.88 / $512.86	Professional		$81.28	$239.88	$512.86
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 / $741.31	Professional		$199.53	$371.54	$741.31
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 / $251.19 / $616.60	Professional	TC	$141.25	$251.19	$616.60
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $588.84 / $2,570.40	Professional		$229.09	$588.84	$2,570.40
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 $162.18 / $398.11 / $1,995.26	Professional	TC	$162.18	$398.11	$1,995.26
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 / $169.82 / $186.21	Professional	TC	$165.96	$169.82	$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 $218.78 / $380.19 / $707.95	Professional		$218.78	$380.19	$707.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $79.43 / $125.89	Professional	26	$61.66	$79.43	$125.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $263.03 / $602.56	Professional	TC	$151.36	$263.03	$602.56