Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.84 / $22.66 / $27.27	Facility	26	$13.84	$22.66	$27.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $56.75 / $71.06 / $168.27	Professional		$56.75	$71.06	$168.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.42 / $18.18 / $73.09	Professional	26	$13.42	$18.18	$73.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.39 / $52.28 / $93.10	Professional	TC	$42.39	$52.28	$93.10
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $45.53 / $53.82 / $68.18	Professional		$45.53	$53.82	$68.18
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $12.43 / $18.44 / $21.48	Professional	26	$12.43	$18.44	$21.48
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $74.59 / $74.59 / $74.59	Professional	TC	$74.59	$74.59	$74.59
BCBS Facility/Professional Professional Modifier Low / Median / High Price $19.23 / $81.22 / $142.88	Professional		$19.23	$81.22	$142.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $54.44 / $87.70 / $132.07	Professional		$54.44	$87.70	$132.07
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.79 / $20.75 / $32.03	Professional	26	$12.79	$20.75	$32.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $42.77 / $67.88 / $103.32	Professional	TC	$42.77	$67.88	$103.32
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $81.06 / $120.07 / $294.26	Professional		$81.06	$120.07	$294.26
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.07 / $26.13 / $100.47	Professional	26	$18.07	$26.13	$100.47
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $61.71 / $89.09 / $218.88	Professional	TC	$61.71	$89.09	$218.88
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 $82.65 / $84.68 / $91.82	Professional		$82.65	$84.68	$91.82
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.14 / $18.80 / $19.98	Professional	26	$18.14	$18.80	$19.98
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $63.86 / $66.53 / $71.83	Professional	TC	$63.86	$66.53	$71.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $20.90 / $32.34 / $96.06	Professional		$20.90	$32.34	$96.06
United Facility/Professional Professional Modifier Low / Median / High Price $61.25 / $82.88 / $128.66	Professional		$61.25	$82.88	$128.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.10 / $19.63 / $31.40	Professional	26	$16.10	$19.63	$31.40
United Facility/Professional Professional Modifier TC Low / Median / High Price $46.16 / $62.79 / $95.65	Professional	TC	$46.16	$62.79	$95.65