Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $163.10 / $362.29 / $1,097.40	Facility		$163.10	$362.29	$1,097.40
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.20 / $80.78 / $96.09	Facility	26	$42.20	$80.78	$96.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $140.96 / $192.25 / $315.17	Professional		$140.96	$192.25	$315.17
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $58.72 / $113.37	Professional	26	$39.81	$58.72	$113.37
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $94.39 / $94.39 / $94.39	Professional	52	$94.39	$94.39	$94.39
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $99.99 / $137.69 / $198.58	Professional	TC	$99.99	$137.69	$198.58
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $108.58 / $147.86 / $147.86	Professional		$108.58	$147.86	$147.86
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $34.20 / $44.37 / $51.77	Professional	26	$34.20	$44.37	$51.77
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $27.89 / $37.44 / $37.44	Professional	52	$27.89	$37.44	$37.44
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $87.97 / $87.97 / $103.49	Professional	TC	$87.97	$87.97	$103.49
BCBS Facility/Professional Facility Modifier Low / Median / High Price $215.29 / $958.55 / $2,229.89	Facility		$215.29	$958.55	$2,229.89
BCBS Facility/Professional Professional Modifier Low / Median / High Price $42.79 / $110.06 / $196.95	Professional		$42.79	$110.06	$196.95
Cigna Facility/Professional Facility Modifier Low / Median / High Price $208.24 / $250.00 / $432.55	Facility		$208.24	$250.00	$432.55
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.86 / $44.86 / $44.86	Facility	26	$44.86	$44.86	$44.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $137.26 / $218.44 / $363.88	Professional		$137.26	$218.44	$363.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.85 / $62.88 / $102.84	Professional	26	$40.85	$62.88	$102.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $96.48 / $154.31 / $257.00	Professional	TC	$96.48	$154.31	$257.00
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $126.89 / $192.86 / $853.71	Professional		$126.89	$192.86	$853.71
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.64 / $55.20 / $245.04	Professional	26	$38.64	$55.20	$245.04
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $85.98 / $122.32 / $288.11	Professional	TC	$85.98	$122.32	$288.11
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 $151.78 / $155.16 / $167.14	Professional		$151.78	$155.16	$167.14
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $42.63 / $47.02 / $50.15	Professional	26	$42.63	$47.02	$50.15
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $99.44 / $103.94 / $116.99	Professional	TC	$99.44	$103.94	$116.99
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $51.52 / $163.44	Professional		$32.34	$51.52	$163.44
United Facility/Professional Professional Modifier Low / Median / High Price $153.47 / $247.27 / $397.95	Professional		$153.47	$247.27	$397.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.05 / $66.44 / $106.82	Professional	26	$42.05	$66.44	$106.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $110.78 / $184.17 / $278.22	Professional	TC	$110.78	$184.17	$278.22