Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.43 / $41.31 / $58.75	Facility	26	$30.43	$41.31	$58.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $108.01 / $178.83 / $492.71	Professional		$108.01	$178.83	$492.71
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.75 / $54.09 / $175.75	Professional	26	$29.75	$54.09	$175.75
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $49.10 / $60.95 / $249.00	Professional	52	$49.10	$60.95	$249.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $72.98 / $95.11 / $263.07	Professional	TC	$72.98	$95.11	$263.07
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $76.77 / $90.36 / $154.66	Professional		$76.77	$90.36	$154.66
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $24.04 / $27.88 / $43.28	Professional	26	$24.04	$27.88	$43.28
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $17.52 / $17.52 / $21.90	Professional	52	$17.52	$17.52	$21.90
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $72.51 / $80.62 / $102.29	Professional	TC	$72.51	$80.62	$102.29
BCBS Facility/Professional Professional Modifier Low / Median / High Price $41.34 / $134.37 / $261.67	Professional		$41.34	$134.37	$261.67
Cigna Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $155.38 / $224.41	Professional		$97.72	$155.38	$224.41
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.95 / $45.51 / $66.26	Professional	26	$28.95	$45.51	$66.26
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $65.94 / $113.29 / $167.58	Professional	TC	$65.94	$113.29	$167.58
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $122.30 / $180.63 / $605.80	Professional		$122.30	$180.63	$605.80
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.51 / $52.86 / $237.88	Professional	26	$36.51	$52.86	$237.88
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $83.46 / $123.28 / $298.93	Professional	TC	$83.46	$123.28	$298.93
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 $138.91 / $141.99 / $153.47	Professional		$138.91	$141.99	$153.47
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $39.90 / $40.72 / $42.95	Professional	26	$39.90	$40.72	$42.95
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $98.19 / $102.09 / $110.53	Professional	TC	$98.19	$102.09	$110.53
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $44.93 / $160.56	Professional		$32.34	$44.93	$160.56
United Facility/Professional Professional Modifier Low / Median / High Price $101.06 / $150.13 / $250.68	Professional		$101.06	$150.13	$250.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.64 / $41.75 / $65.37	Professional	26	$32.64	$41.75	$65.37
United Facility/Professional Professional Modifier TC Low / Median / High Price $79.45 / $104.92 / $161.74	Professional	TC	$79.45	$104.92	$161.74