Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.69 / $58.88 / $128.82	Facility	26	$41.69	$58.88	$128.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $229.09 / $724.44	Professional		$131.83	$229.09	$724.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $70.79 / $158.49	Professional	26	$42.66	$70.79	$158.49
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $30.20 / $263.03 / $263.03	Professional	52	$30.20	$263.03	$263.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $131.83 / $309.03	Professional	TC	$95.50	$131.83	$309.03
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $131.83 / $257.04	Professional		$112.20	$131.83	$257.04
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $47.86 / $66.07	Professional	26	$35.48	$47.86	$66.07
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $109.65 / $154.88	Professional	TC	$72.44	$109.65	$154.88
BCBS Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $154.88 / $354.81	Professional		$58.88	$154.88	$354.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $213.80 / $316.23	Professional		$128.82	$213.80	$316.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $63.10 / $95.50	Professional	26	$39.81	$63.10	$95.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $154.88 / $223.87	Professional	TC	$97.72	$154.88	$223.87
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $398.11 / $1,000.00	Professional		$181.97	$398.11	$1,000.00
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $144.54 / $295.12	Professional	26	$56.23	$144.54	$295.12
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $194.98 / $707.95	Professional	TC	$128.82	$194.98	$707.95
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 $186.21 / $190.55 / $204.17	Professional		$186.21	$190.55	$204.17
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $57.54 / $61.66	Professional	26	$57.54	$57.54	$61.66
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $134.90 / $144.54	Professional	TC	$128.82	$134.90	$144.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $33.11	Professional		$32.36	$33.11	$33.11
United Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $204.17 / $302.00	Professional		$158.49	$204.17	$302.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $60.26 / $91.20	Professional	26	$47.86	$60.26	$91.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $144.54 / $213.80	Professional	TC	$109.65	$144.54	$213.80