Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.82 / $21.15 / $25.52	Facility	26	$12.82	$21.15	$25.52
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $36.11 / $57.69 / $252.83	Facility	TC	$36.11	$57.69	$252.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $44.27 / $55.86 / $105.49	Professional		$44.27	$55.86	$105.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.43 / $15.43 / $42.40	Professional	26	$12.43	$15.43	$42.40
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $75.15 / $86.82 / $86.82	Professional	50	$75.15	$86.82	$86.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.85 / $37.77 / $68.84	Professional	TC	$30.85	$37.77	$68.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $35.02 / $48.74 / $52.30	Professional		$35.02	$48.74	$52.30
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.09 / $14.07 / $18.98	Professional	26	$10.09	$14.07	$18.98
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $29.34 / $29.34 / $29.34	Professional	TC	$29.34	$29.34	$29.34
BCBS Facility/Professional Professional Modifier Low / Median / High Price $17.61 / $62.49 / $119.79	Professional		$17.61	$62.49	$119.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $42.02 / $68.62 / $101.17	Professional		$42.02	$68.62	$101.17
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.94 / $19.16 / $29.90	Professional	26	$11.94	$19.16	$29.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $31.12 / $49.13 / $74.86	Professional	TC	$31.12	$49.13	$74.86
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $62.37 / $93.19 / $248.07	Professional		$62.37	$93.19	$248.07
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $16.71 / $24.07 / $93.51	Professional	26	$16.71	$24.07	$93.51
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $44.03 / $59.37 / $125.85	Professional	TC	$44.03	$59.37	$125.85
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 $63.60 / $65.20 / $70.33	Professional		$63.60	$65.20	$70.33
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.16 / $17.38 / $18.29	Professional	26	$17.16	$17.38	$18.29
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $44.23 / $46.22 / $52.04	Professional	TC	$44.23	$46.22	$52.04
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.14 / $32.34 / $73.58	Professional		$19.14	$32.34	$73.58
United Facility/Professional Professional Modifier Low / Median / High Price $47.42 / $62.02 / $94.84	Professional		$47.42	$62.02	$94.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.86 / $18.25 / $28.19	Professional	26	$14.86	$18.25	$28.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $33.49 / $45.04 / $69.77	Professional	TC	$33.49	$45.04	$69.77