Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.77 / $14.79 / $33.11	Facility	26	$9.77	$14.79	$33.11
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $33.11 / $64.57 / $588.84	Facility	TC	$33.11	$64.57	$588.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $19.05 / $58.88 / $199.53	Professional		$19.05	$58.88	$199.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $22.39 / $64.57	Professional	26	$10.00	$22.39	$64.57
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $40.74 / $128.82 / $363.08	Professional	50	$40.74	$128.82	$363.08
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $43.65 / $43.65 / $43.65	Professional	52	$43.65	$43.65	$43.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $46.77 / $112.20	Professional	TC	$28.84	$46.77	$112.20
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $38.02 / $61.66	Professional		$30.90	$38.02	$61.66
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $10.72 / $19.05	Professional	26	$8.13	$10.72	$19.05
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $43.65 / $58.88 / $87.10	Professional	50	$43.65	$58.88	$87.10
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $40.74 / $61.66	Professional	TC	$26.30	$40.74	$61.66
BCBS Facility/Professional Professional Modifier Low / Median / High Price $13.80 / $54.95 / $104.71	Professional		$13.80	$54.95	$104.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $54.95 / $85.11	Professional		$35.48	$54.95	$85.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $15.14 / $22.91	Professional	26	$9.33	$15.14	$22.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $41.69 / $66.07	Professional	TC	$26.30	$41.69	$66.07
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $104.71 / $257.04	Professional		$51.29	$104.71	$257.04
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $22.39 / $77.62	Professional	26	$13.49	$22.39	$77.62
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $57.54 / $186.21	Professional	TC	$36.31	$57.54	$186.21
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 $56.23 / $57.54 / $61.66	Professional		$56.23	$57.54	$61.66
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $13.80 / $14.45	Professional	26	$13.49	$13.80	$14.45
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $43.65 / $46.77	Professional	TC	$41.69	$43.65	$46.77
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $33.11	Professional		$32.36	$33.11	$33.11
United Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $50.12 / $75.86	Professional		$38.02	$50.12	$75.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.72 / $13.49 / $20.42	Professional	26	$10.72	$13.49	$20.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $36.31 / $56.23	Professional	TC	$27.54	$36.31	$56.23