Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $122.67 / $198.29 / $290.83	Facility	26	$122.67	$198.29	$290.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $592.04 / $777.87 / $1,170.57	Professional		$592.04	$777.87	$1,170.57
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $118.20 / $152.85 / $355.76	Professional	26	$118.20	$152.85	$355.76
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $258.77 / $335.49 / $467.76	Professional	52	$258.77	$335.49	$467.76
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $472.98 / $654.08 / $1,047.60	Professional	TC	$472.98	$654.08	$1,047.60
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $757.74 / $757.74 / $757.74	Professional		$757.74	$757.74	$757.74
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $113.15 / $145.99 / $164.24	Professional	26	$113.15	$145.99	$164.24
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $189.43 / $189.43 / $189.43	Professional	52	$189.43	$189.43	$189.43
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $617.83 / $617.83 / $617.83	Professional	TC	$617.83	$617.83	$617.83
BCBS Facility/Professional Professional Modifier Low / Median / High Price $134.91 / $558.53 / $1,033.58	Professional		$134.91	$558.53	$1,033.58
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $139.38 / $139.38 / $139.38	Facility	26	$139.38	$139.38	$139.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $657.67 / $930.14 / $1,479.99	Professional		$657.67	$930.14	$1,479.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $127.74 / $186.14 / $281.83	Professional	26	$127.74	$186.14	$281.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $531.29 / $752.14 / $1,221.35	Professional	TC	$531.29	$752.14	$1,221.35
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $638.59 / $988.35 / $3,212.33	Professional		$638.59	$988.35	$3,212.33
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $127.28 / $194.39 / $740.00	Professional	26	$127.28	$194.39	$740.00
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $524.47 / $770.92 / $2,480.11	Professional	TC	$524.47	$770.92	$2,480.11
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 $728.08 / $770.25 / $856.57	Professional		$728.08	$770.25	$856.57
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $134.43 / $147.75 / $158.16	Professional	26	$134.43	$147.75	$158.16
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $593.65 / $619.83 / $698.41	Professional	TC	$593.65	$619.83	$698.41
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $115.71 / $829.50	Professional		$32.34	$115.71	$829.50
United Facility/Professional Professional Modifier Low / Median / High Price $611.89 / $958.14 / $1,471.11	Professional		$611.89	$958.14	$1,471.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $120.60 / $190.71 / $296.18	Professional	26	$120.60	$190.71	$296.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $491.01 / $755.20 / $1,195.86	Professional	TC	$491.01	$755.20	$1,195.86