Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $149.58 / $443.00 / $990.34	Facility		$149.58	$443.00	$990.34
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.48 / $35.15 / $38.40	Facility	26	$22.48	$35.15	$38.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $119.81 / $178.25 / $390.68	Professional		$119.81	$178.25	$390.68
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.34 / $24.48 / $92.23	Professional	26	$20.34	$24.48	$92.23
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $56.28 / $66.90 / $101.32	Professional	52	$56.28	$66.90	$101.32
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $98.16 / $149.78 / $238.50	Professional	TC	$98.16	$149.78	$238.50
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $83.78 / $102.08 / $122.73	Professional		$83.78	$102.08	$122.73
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $18.04 / $23.33 / $30.00	Professional	26	$18.04	$23.33	$30.00
BCBS Facility/Professional Facility Modifier Low / Median / High Price $207.26 / $523.60 / $1,811.26	Facility		$207.26	$523.60	$1,811.26
BCBS Facility/Professional Professional Modifier Low / Median / High Price $24.65 / $78.89 / $228.98	Professional		$24.65	$78.89	$228.98
Cigna Facility/Professional Facility Modifier Low / Median / High Price $184.82 / $305.10 / $916.00	Facility		$184.82	$305.10	$916.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $125.58 / $183.49 / $279.75	Professional		$125.58	$183.49	$279.75
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.23 / $30.00 / $45.99	Professional	26	$21.23	$30.00	$45.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $106.52 / $152.41 / $231.52	Professional	TC	$106.52	$152.41	$231.52
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $135.80 / $200.52 / $452.47	Professional		$135.80	$200.52	$452.47
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $24.44 / $33.45 / $159.24	Professional	26	$24.44	$33.45	$159.24
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $113.74 / $152.68 / $309.95	Professional	TC	$113.74	$152.68	$309.95
Hally Health Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $100.00 / $100.00	Facility		$100.00	$100.00	$100.00
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 $152.43 / $155.25 / $170.38	Professional		$152.43	$155.25	$170.38
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $24.86 / $26.81 / $28.89	Professional	26	$24.86	$26.81	$28.89
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $125.62 / $130.40 / $141.49	Professional	TC	$125.62	$130.40	$141.49
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.22 / $32.34 / $178.24	Professional		$30.22	$32.34	$178.24
United Facility/Professional Professional Modifier Low / Median / High Price $134.82 / $192.75 / $282.39	Professional		$134.82	$192.75	$282.39
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.22 / $34.04 / $56.27	Professional	26	$22.22	$34.04	$56.27
United Facility/Professional Professional Modifier TC Low / Median / High Price $111.36 / $162.76 / $247.24	Professional	TC	$111.36	$162.76	$247.24