Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.77 / $14.71 / $19.88	Facility	26	$9.77	$14.71	$19.88
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $33.99 / $58.02 / $611.29	Facility	TC	$33.99	$58.02	$611.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.66 / $58.10 / $182.96	Professional		$28.66	$58.10	$182.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.94 / $17.27 / $62.40	Professional	26	$9.94	$17.27	$62.40
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $40.63 / $139.71 / $414.00	Professional	50	$40.63	$139.71	$414.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $17.14 / $22.25 / $33.03	Professional	52	$17.14	$22.25	$33.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.87 / $36.25 / $86.45	Professional	TC	$27.87	$36.25	$86.45
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $34.10 / $44.88 / $64.15	Professional		$34.10	$44.88	$64.15
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.96 / $9.40 / $15.03	Professional	26	$7.96	$9.40	$15.03
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $52.55 / $63.98 / $86.48	Professional	50	$52.55	$63.98	$86.48
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $30.93 / $42.08 / $50.10	Professional	TC	$30.93	$42.08	$50.10
BCBS Facility/Professional Professional Modifier Low / Median / High Price $13.93 / $54.70 / $104.86	Professional		$13.93	$54.70	$104.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.72 / $56.54 / $85.64	Professional		$35.72	$56.54	$85.64
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.40 / $15.02 / $23.57	Professional	26	$9.40	$15.02	$23.57
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $53.72 / $53.72 / $61.21	Professional	50	$53.72	$53.72	$61.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.05 / $43.41 / $68.05	Professional	TC	$26.05	$43.41	$68.05
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $52.27 / $76.03 / $226.02	Professional		$52.27	$76.03	$226.02
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.40 / $18.92 / $77.05	Professional	26	$13.40	$18.92	$77.05
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $36.39 / $54.59 / $142.66	Professional	TC	$36.39	$54.59	$142.66
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 $55.67 / $57.02 / $61.78	Professional		$55.67	$57.02	$61.78
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.42 / $13.66 / $14.47	Professional	26	$13.42	$13.66	$14.47
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $42.00 / $43.60 / $47.31	Professional	TC	$42.00	$43.60	$47.31
Molina Facility/Professional Professional Modifier Low / Median / High Price $15.14 / $32.34 / $64.63	Professional		$15.14	$32.34	$64.63
United Facility/Professional Professional Modifier Low / Median / High Price $39.56 / $53.99 / $82.54	Professional		$39.56	$53.99	$82.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.98 / $13.89 / $21.47	Professional	26	$10.98	$13.89	$21.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.67 / $39.29 / $63.74	Professional	TC	$28.67	$39.29	$63.74