Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $68.28 / $105.92 / $160.47	Facility	26	$68.28	$105.92	$160.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $144.88 / $394.25 / $1,190.00	Professional		$144.88	$394.25	$1,190.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.81 / $126.32 / $386.40	Professional	26	$67.81	$126.32	$386.40
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $126.06 / $236.19 / $1,135.10	Professional	50	$126.06	$236.19	$1,135.10
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $104.71 / $143.88 / $237.50	Professional	52	$104.71	$143.88	$237.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $154.28 / $268.52 / $472.35	Professional	TC	$154.28	$268.52	$472.35
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $149.06 / $187.05 / $280.11	Professional		$149.06	$187.05	$280.11
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $46.39 / $56.22 / $86.99	Professional	26	$46.39	$56.22	$86.99
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $121.45 / $134.86 / $171.75	Professional	TC	$121.45	$134.86	$171.75
BCBS Facility/Professional Professional Modifier Low / Median / High Price $80.64 / $239.92 / $509.21	Professional		$80.64	$239.92	$509.21
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.30 / $85.30 / $85.30	Facility	26	$85.30	$85.30	$85.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $201.01 / $334.17 / $731.19	Professional		$201.01	$334.17	$731.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.79 / $87.23 / $134.25	Professional	26	$53.79	$87.23	$134.25
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 $139.38 / $222.44 / $602.23	Professional	TC	$139.38	$222.44	$602.23
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $233.43 / $362.30 / $2,339.80	Professional		$233.43	$362.30	$2,339.80
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 $161.57 / $253.44 / $1,945.19	Professional	TC	$161.57	$253.44	$1,945.19
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 $244.15 / $249.17 / $269.14	Professional		$244.15	$249.17	$269.14
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 $164.74 / $171.44 / $185.37	Professional	TC	$164.74	$171.44	$185.37
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $87.64 / $281.56	Professional		$32.34	$87.64	$281.56
United Facility/Professional Professional Modifier Low / Median / High Price $232.36 / $392.85 / $669.61	Professional		$232.36	$392.85	$669.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $65.59 / $83.63 / $149.68	Professional	26	$65.59	$83.63	$149.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $161.60 / $269.82 / $546.59	Professional	TC	$161.60	$269.82	$546.59