Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.88 / $26.92 / $44.67	Facility	26	$12.88	$26.92	$44.67
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $30.20 / $52.48 / $97.72	Facility	TC	$30.20	$52.48	$97.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $45.71 / $138.04	Professional		$36.31	$45.71	$138.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $16.98 / $53.70	Professional	26	$12.02	$16.98	$53.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $30.20 / $56.23	Professional	TC	$22.91	$30.20	$56.23
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $33.88 / $33.88	Professional		$33.88	$33.88	$33.88
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $15.14 / $15.14	Professional	26	$15.14	$15.14	$15.14
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $28.18 / $28.18	Professional	TC	$28.18	$28.18	$28.18
BCBS Facility/Professional Professional Modifier Low / Median / High Price $18.62 / $53.70 / $102.33	Professional		$18.62	$53.70	$102.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $56.23 / $83.18	Professional		$36.31	$56.23	$83.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $20.42 / $31.62	Professional	26	$12.59	$20.42	$31.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $36.31 / $57.54	Professional	TC	$23.99	$36.31	$57.54
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $151.36 / $288.40	Professional		$53.70	$151.36	$288.40
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $37.15 / $134.90	Professional	26	$17.38	$37.15	$134.90
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $44.67 / $147.91	Professional	TC	$33.11	$44.67	$147.91
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 Facility Modifier TC Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	TC	$100.00	$100.00	$100.00
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $54.95 / $60.26	Professional		$53.70	$54.95	$60.26
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $18.20 / $19.05	Professional	26	$18.20	$18.20	$19.05
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $35.48 / $40.74	Professional	TC	$34.67	$35.48	$40.74
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $33.11	Professional		$32.36	$33.11	$33.11
United Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $51.29 / $77.62	Professional		$40.74	$51.29	$77.62
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $19.50 / $29.51	Professional	26	$15.14	$19.50	$29.51
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $33.11 / $50.12	Professional	TC	$24.55	$33.11	$50.12