Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $123.03 / $165.96 / $257.04	Facility	26	$123.03	$165.96	$257.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $794.33 / $1,698.24	Professional		$588.84	$794.33	$1,698.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $218.78 / $575.44	Professional	26	$120.23	$218.78	$575.44
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $117.49 / $257.04 / $1,258.93	Professional	52	$117.49	$257.04	$1,258.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $467.74 / $616.60 / $1,348.96	Professional	TC	$467.74	$616.60	$1,348.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $616.60 / $724.44	Professional		$537.03	$616.60	$724.44
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $128.82 / $186.21	Professional	26	$107.15	$128.82	$186.21
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $141.25 / $141.25 / $141.25	Professional	52	$141.25	$141.25	$141.25
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $457.09 / $512.86	Professional	TC	$323.59	$457.09	$512.86
BCBS Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $562.34 / $1,023.29	Professional		$134.90	$562.34	$1,023.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $660.69 / $912.01 / $1,445.44	Professional		$660.69	$912.01	$1,445.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $186.21 / $275.42	Professional	26	$128.82	$186.21	$275.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $524.81 / $741.31 / $1,174.90	Professional	TC	$524.81	$741.31	$1,174.90
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $602.56 / $1,023.29 / $3,715.35	Professional		$602.56	$1,023.29	$3,715.35
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $213.80 / $831.76	Professional	26	$123.03	$213.80	$831.76
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $501.19 / $812.83 / $2,951.21	Professional	TC	$501.19	$812.83	$2,951.21
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 $724.44 / $776.25 / $851.14	Professional		$724.44	$776.25	$851.14
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $147.91 / $158.49	Professional	26	$134.90	$147.91	$158.49
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $588.84 / $616.60 / $691.83	Professional	TC	$588.84	$616.60	$691.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $218.78	Professional		$32.36	$33.11	$218.78
United Facility/Professional Professional Modifier Low / Median / High Price $616.60 / $912.01 / $1,348.96	Professional		$616.60	$912.01	$1,348.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $186.21 / $281.84	Professional	26	$120.23	$186.21	$281.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $489.78 / $707.95 / $1,071.52	Professional	TC	$489.78	$707.95	$1,071.52