Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $117.49 / $154.88 / $234.42	Facility	26	$117.49	$154.88	$234.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $562.34 / $758.58 / $1,659.59	Professional		$562.34	$758.58	$1,659.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $204.17 / $562.34	Professional	26	$114.82	$204.17	$562.34
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $190.55 / $269.15 / $1,202.26	Professional	52	$190.55	$269.15	$1,202.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $446.68 / $588.84 / $1,479.11	Professional	TC	$446.68	$588.84	$1,479.11
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $562.34 / $691.83	Professional		$524.81	$562.34	$691.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $120.23 / $162.18	Professional	26	$102.33	$120.23	$162.18
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $467.74 / $645.65	Professional	TC	$302.00	$467.74	$645.65
BCBS Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $537.03 / $977.24	Professional		$128.82	$537.03	$977.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $870.96 / $1,348.96	Professional		$630.96	$870.96	$1,348.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $177.83 / $263.03	Professional	26	$123.03	$177.83	$263.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $501.19 / $707.95 / $1,122.02	Professional	TC	$501.19	$707.95	$1,122.02
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $954.99 / $3,388.44	Professional		$575.44	$954.99	$3,388.44
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $204.17 / $1,000.00	Professional	26	$117.49	$204.17	$1,000.00
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $478.63 / $758.58 / $2,691.53	Professional	TC	$478.63	$758.58	$2,691.53
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 $691.83 / $741.31 / $812.83	Professional		$691.83	$741.31	$812.83
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $141.25 / $151.36	Professional	26	$128.82	$141.25	$151.36
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $562.34 / $588.84 / $660.69	Professional	TC	$562.34	$588.84	$660.69
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $75.86	Professional		$32.36	$33.11	$75.86
United Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $851.14 / $1,288.25	Professional		$588.84	$851.14	$1,288.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $173.78 / $269.15	Professional	26	$114.82	$173.78	$269.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $457.09 / $676.08 / $1,023.29	Professional	TC	$457.09	$676.08	$1,023.29