Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.33 / $41.32 / $46.74	Facility	26	$25.33	$41.32	$46.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $49.43 / $81.40 / $167.67	Professional		$49.43	$81.40	$167.67
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.46 / $34.32 / $106.43	Professional	26	$23.46	$34.32	$106.43
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $24.44 / $32.72 / $90.15	Professional	52	$24.44	$32.72	$90.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.59 / $53.25 / $100.81	Professional	TC	$24.59	$53.25	$100.81
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $34.89 / $43.79 / $58.86	Professional		$34.89	$43.79	$58.86
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.78 / $23.13 / $38.72	Professional	26	$5.78	$23.13	$38.72
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $8.76 / $12.06 / $55.20	Professional	52	$8.76	$12.06	$55.20
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $22.74 / $37.25 / $37.25	Professional	TC	$22.74	$37.25	$37.25
BCBS Facility/Professional Professional Modifier Low / Median / High Price $34.36 / $66.65 / $131.30	Professional		$34.36	$66.65	$131.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $56.02 / $87.84 / $149.40	Professional		$56.02	$87.84	$149.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.00 / $37.08 / $52.84	Professional	26	$23.00	$37.08	$52.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.97 / $50.54 / $102.52	Professional	TC	$28.97	$50.54	$102.52
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $64.42 / $97.80 / $384.68	Professional		$64.42	$97.80	$384.68
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $30.34 / $43.94 / $184.93	Professional	26	$30.34	$43.94	$184.93
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $32.65 / $49.76 / $211.42	Professional	TC	$32.65	$49.76	$211.42
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 $69.70 / $70.03 / $76.13	Professional		$69.70	$70.03	$76.13
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.88 / $33.84 / $35.70	Professional	26	$32.88	$33.84	$35.70
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $35.86 / $37.17 / $40.43	Professional	TC	$35.86	$37.17	$40.43
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $36.44 / $79.64	Professional		$32.34	$36.44	$79.64
United Facility/Professional Professional Modifier Low / Median / High Price $75.56 / $99.84 / $150.84	Professional		$75.56	$99.84	$150.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.49 / $35.78 / $58.34	Professional	26	$26.49	$35.78	$58.34
United Facility/Professional Professional Modifier TC Low / Median / High Price $45.20 / $66.15 / $100.52	Professional	TC	$45.20	$66.15	$100.52