Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.24 / $21.65 / $30.83	Facility	26	$13.24	$21.65	$30.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.16 / $67.66 / $133.01	Professional		$53.16	$67.66	$133.01
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.85 / $16.71 / $38.99	Professional	26	$12.85	$16.71	$38.99
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $39.72 / $50.93 / $82.60	Professional	TC	$39.72	$50.93	$82.60
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $40.15 / $55.80 / $60.20	Professional		$40.15	$55.80	$60.20
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.64 / $17.66 / $20.55	Professional	26	$10.64	$17.66	$20.55
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $34.97 / $65.66 / $65.66	Professional	TC	$34.97	$65.66	$65.66
BCBS Facility/Professional Professional Modifier Low / Median / High Price $18.42 / $71.76 / $126.25	Professional		$18.42	$71.76	$126.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $50.52 / $84.18 / $123.83	Professional		$50.52	$84.18	$123.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.06 / $20.96 / $33.88	Professional	26	$13.06	$20.96	$33.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.65 / $61.93 / $94.96	Professional	TC	$38.65	$61.93	$94.96
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $71.63 / $104.14 / $281.95	Professional		$71.63	$104.14	$281.95
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.32 / $25.62 / $106.63	Professional	26	$17.32	$25.62	$106.63
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $52.60 / $76.20 / $185.20	Professional	TC	$52.60	$76.20	$185.20
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 $73.03 / $74.61 / $81.06	Professional		$73.03	$74.61	$81.06
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.32 / $17.98 / $19.14	Professional	26	$17.32	$17.98	$19.14
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $55.04 / $57.28 / $61.93	Professional	TC	$55.04	$57.28	$61.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $20.02 / $32.34 / $84.81	Professional		$20.02	$32.34	$84.81
United Facility/Professional Professional Modifier Low / Median / High Price $57.43 / $78.64 / $112.97	Professional		$57.43	$78.64	$112.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.50 / $20.50 / $32.82	Professional	26	$15.50	$20.50	$32.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $57.92 / $86.65	Professional	TC	$41.69	$57.92	$86.65