Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.60 / $59.04 / $84.92	Facility	26	$41.60	$59.04	$84.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $133.59 / $171.16 / $495.56	Professional		$133.59	$171.16	$495.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.61 / $52.06 / $147.25	Professional	26	$41.61	$52.06	$147.25
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $263.23 / $263.23 / $263.23	Professional	52	$263.23	$263.23	$263.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $93.01 / $120.78 / $210.69	Professional	TC	$93.01	$120.78	$210.69
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $106.12 / $143.34 / $159.80	Professional		$106.12	$143.34	$159.80
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $33.90 / $44.81 / $62.30	Professional	26	$33.90	$44.81	$62.30
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $95.06 / $95.06 / $106.00	Professional	TC	$95.06	$95.06	$106.00
BCBS Facility/Professional Professional Modifier Low / Median / High Price $58.94 / $183.80 / $352.34	Professional		$58.94	$183.80	$352.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $132.38 / $214.10 / $326.98	Professional		$132.38	$214.10	$326.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.54 / $63.58 / $99.64	Professional	26	$39.54	$63.58	$99.64
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $96.22 / $151.19 / $238.39	Professional	TC	$96.22	$151.19	$238.39
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $179.18 / $269.60 / $793.70	Professional		$179.18	$269.60	$793.70
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $54.64 / $80.55 / $286.56	Professional	26	$54.64	$80.55	$286.56
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $126.39 / $178.43 / $518.48	Professional	TC	$126.39	$178.43	$518.48
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 $187.04 / $191.39 / $206.17	Professional		$187.04	$191.39	$206.17
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $57.10 / $58.18 / $61.23	Professional	26	$57.10	$58.18	$61.23
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $128.87 / $134.29 / $144.94	Professional	TC	$128.87	$134.29	$144.94
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $64.06 / $215.68	Professional		$32.34	$64.06	$215.68
United Facility/Professional Professional Modifier Low / Median / High Price $170.30 / $210.30 / $306.61	Professional		$170.30	$210.30	$306.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.88 / $63.13 / $94.53	Professional	26	$50.88	$63.13	$94.53
United Facility/Professional Professional Modifier TC Low / Median / High Price $119.27 / $151.91 / $224.86	Professional	TC	$119.27	$151.91	$224.86