Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $147.16 / $1,900.32 / $5,626.24	Facility		$147.16	$1,900.32	$5,626.24
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $81.40 / $135.65 / $147.53	Facility	26	$81.40	$135.65	$147.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $130.47 / $201.59 / $307.29	Professional		$130.47	$201.59	$307.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.86 / $78.72 / $148.35	Professional	26	$48.86	$78.72	$148.35
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $64.06 / $76.75 / $140.71	Professional	52	$64.06	$76.75	$140.71
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $57.80 / $116.53 / $202.54	Professional	TC	$57.80	$116.53	$202.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $97.12 / $105.38 / $106.56	Professional		$97.12	$105.38	$106.56
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $57.66 / $63.75 / $91.66	Professional	26	$57.66	$63.75	$91.66
BCBS Facility/Professional Facility Modifier Low / Median / High Price $637.04 / $1,054.90 / $3,957.80	Facility		$637.04	$1,054.90	$3,957.80
BCBS Facility/Professional Professional Modifier Low / Median / High Price $107.94 / $192.40 / $341.86	Professional		$107.94	$192.40	$341.86
Cigna Facility/Professional Facility Modifier Low / Median / High Price $152.27 / $230.91 / $712.52	Facility		$152.27	$230.91	$712.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $131.99 / $232.50 / $633.12	Professional		$131.99	$232.50	$633.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.09 / $99.19 / $156.91	Professional	26	$60.09	$99.19	$156.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $62.30 / $114.18 / $539.83	Professional	TC	$62.30	$114.18	$539.83
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $169.88 / $279.20 / $1,134.81	Professional		$169.88	$279.20	$1,134.81
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $90.56 / $138.00 / $672.56	Professional	26	$90.56	$138.00	$672.56
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $74.58 / $107.98 / $887.32	Professional	TC	$74.58	$107.98	$887.32
Hally Health Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $100.00 / $100.00	Facility		$100.00	$100.00	$100.00
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 $175.53 / $181.48 / $199.86	Professional		$175.53	$181.48	$199.86
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $94.76 / $103.62 / $112.13	Professional	26	$94.76	$103.62	$112.13
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $77.86 / $80.77 / $87.74	Professional	TC	$77.86	$80.77	$87.74
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $83.85 / $209.09	Professional		$32.34	$83.85	$209.09
United Facility/Professional Professional Modifier Low / Median / High Price $166.52 / $253.54 / $555.58	Professional		$166.52	$253.54	$555.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $59.54 / $96.79 / $163.09	Professional	26	$59.54	$96.79	$163.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.95 / $132.94 / $304.37	Professional	TC	$77.95	$132.94	$304.37