Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $108.14 / $162.21 / $249.04	Facility	26	$108.14	$162.21	$249.04
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $153.34 / $252.27 / $252.27	Facility	53	$153.34	$252.27	$252.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $690.82 / $996.68 / $1,912.32	Professional		$690.82	$996.68	$1,912.32
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $108.14 / $187.33 / $520.77	Professional	26	$108.14	$187.33	$520.77
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $335.54 / $404.25 / $605.58	Professional	52	$335.54	$404.25	$605.58
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $137.60 / $161.69 / $242.23	Professional	53	$137.60	$161.69	$242.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $582.66 / $767.26 / $1,165.53	Professional	TC	$582.66	$767.26	$1,165.53
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $93.47 / $93.47 / $148.34	Professional	26	$93.47	$93.47	$148.34
Ambetter Facility/Professional Professional Modifier 53 Low / Median / High Price $776.96 / $776.96 / $776.96	Professional	53	$776.96	$776.96	$776.96
BCBS Facility/Professional Professional Modifier Low / Median / High Price $121.96 / $507.36 / $1,778.92	Professional		$121.96	$507.36	$1,778.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $697.70 / $1,051.33 / $1,758.63	Professional		$697.70	$1,051.33	$1,758.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $113.15 / $181.20 / $314.25	Professional	26	$113.15	$181.20	$314.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $586.07 / $873.57 / $1,452.29	Professional	TC	$586.07	$873.57	$1,452.29
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $761.59 / $1,107.76 / $2,754.49	Professional		$761.59	$1,107.76	$2,754.49
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $129.03 / $183.65 / $1,001.71	Professional	26	$129.03	$183.65	$1,001.71
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $640.62 / $925.33 / $2,094.98	Professional	TC	$640.62	$925.33	$2,094.98
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 $810.80 / $842.87 / $900.06	Professional		$810.80	$842.87	$900.06
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $135.27 / $136.03 / $142.96	Professional	26	$135.27	$136.03	$142.96
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $674.78 / $707.60 / $757.09	Professional	TC	$674.78	$707.60	$757.09
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $149.56 / $941.60	Professional		$32.34	$149.56	$941.60
United Facility/Professional Professional Modifier Low / Median / High Price $838.61 / $1,097.05 / $1,818.39	Professional		$838.61	$1,097.05	$1,818.39
United Facility/Professional Professional Modifier 26 Low / Median / High Price $130.46 / $196.79 / $326.95	Professional	26	$130.46	$196.79	$326.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $689.24 / $932.25 / $1,534.92	Professional	TC	$689.24	$932.25	$1,534.92