Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.95 / $51.01 / $115.77	Facility	26	$33.95	$51.01	$115.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $75.15 / $135.27 / $400.90	Professional		$75.15	$135.27	$400.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.33 / $45.43 / $129.80	Professional	26	$34.33	$45.43	$129.80
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $159.90 / $159.90 / $159.90	Professional	52	$159.90	$159.90	$159.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $72.98 / $93.23 / $162.96	Professional	TC	$72.98	$93.23	$162.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $84.40 / $107.39 / $127.27	Professional		$84.40	$107.39	$127.27
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $27.79 / $35.61 / $52.10	Professional	26	$27.79	$35.61	$52.10
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $64.31 / $64.31 / $83.15	Professional	TC	$64.31	$64.31	$83.15
BCBS Facility/Professional Professional Modifier Low / Median / High Price $48.30 / $146.18 / $277.83	Professional		$48.30	$146.18	$277.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $105.00 / $170.45 / $258.88	Professional		$105.00	$170.45	$258.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.81 / $52.10 / $81.14	Professional	26	$31.81	$52.10	$81.14
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $75.20 / $118.36 / $187.14	Professional	TC	$75.20	$118.36	$187.14
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $142.04 / $210.85 / $538.73	Professional		$142.04	$210.85	$538.73
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $45.68 / $65.77 / $225.56	Professional	26	$45.68	$65.77	$225.56
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $99.31 / $138.69 / $357.91	Professional	TC	$99.31	$138.69	$357.91
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 $148.76 / $151.59 / $164.14	Professional		$148.76	$151.59	$164.14
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $46.29 / $47.50 / $50.17	Professional	26	$46.29	$47.50	$50.17
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $101.26 / $105.31 / $113.97	Professional	TC	$101.26	$105.31	$113.97
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $52.48 / $171.71	Professional		$32.34	$52.48	$171.71
United Facility/Professional Professional Modifier Low / Median / High Price $133.50 / $161.38 / $244.11	Professional		$133.50	$161.38	$244.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.70 / $55.31 / $95.00	Professional	26	$41.70	$55.31	$95.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $93.62 / $119.24 / $171.04	Professional	TC	$93.62	$119.24	$171.04