Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $5.95 / $8.93 / $11.86	Facility	26	$5.95	$8.93	$11.86
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $29.89 / $53.84 / $411.30	Facility	TC	$29.89	$53.84	$411.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $16.26 / $43.01 / $141.18	Professional		$16.26	$43.01	$141.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.83 / $9.61 / $35.83	Professional	26	$5.83	$9.61	$35.83
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $24.62 / $121.45 / $316.00	Professional	50	$24.62	$121.45	$316.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $13.86 / $18.19 / $28.28	Professional	52	$13.86	$18.19	$28.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.57 / $30.11 / $71.11	Professional	TC	$22.57	$30.11	$71.11
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $27.23 / $34.34 / $46.42	Professional		$27.23	$34.34	$46.42
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $4.88 / $5.84 / $9.27	Professional	26	$4.88	$5.84	$9.27
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $26.96 / $38.11 / $42.88	Professional	TC	$26.96	$38.11	$42.88
BCBS Facility/Professional Professional Modifier Low / Median / High Price $8.60 / $44.20 / $77.75	Professional		$8.60	$44.20	$77.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.58 / $45.20 / $69.53	Professional		$26.58	$45.20	$69.53
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.66 / $9.27 / $14.23	Professional	26	$5.66	$9.27	$14.23
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $43.71 / $43.71 / $49.70	Professional	50	$43.71	$43.71	$49.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.72 / $36.52 / $56.53	Professional	TC	$19.72	$36.52	$56.53
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $40.68 / $61.81 / $164.38	Professional		$40.68	$61.81	$164.38
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $8.02 / $11.56 / $46.23	Professional	26	$8.02	$11.56	$46.23
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $29.16 / $47.91 / $99.85	Professional	TC	$29.16	$47.91	$99.85
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 $44.98 / $45.98 / $50.22	Professional		$44.98	$45.98	$50.22
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $8.02 / $8.35 / $8.93	Professional	26	$8.02	$8.35	$8.93
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $36.63 / $37.97 / $41.29	Professional	TC	$36.63	$37.97	$41.29
Molina Facility/Professional Professional Modifier Low / Median / High Price $9.34 / $32.34 / $52.54	Professional		$9.34	$32.34	$52.54
United Facility/Professional Professional Modifier Low / Median / High Price $28.60 / $40.75 / $66.83	Professional		$28.60	$40.75	$66.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.84 / $8.82 / $13.50	Professional	26	$6.84	$8.82	$13.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.00 / $33.01 / $53.34	Professional	TC	$23.00	$33.01	$53.34