Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.15 / $40.92 / $54.77	Facility	26	$30.15	$40.92	$54.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.64 / $59.44 / $197.00	Professional		$28.64	$59.44	$197.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.80 / $41.55 / $131.10	Professional	26	$17.80	$41.55	$131.10
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $46.70 / $60.85 / $60.85	Professional	50	$46.70	$60.85	$60.85
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $8.03 / $11.47 / $54.60	Professional	TC	$8.03	$11.47	$54.60
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $39.79 / $50.81 / $80.56	Professional		$39.79	$50.81	$80.56
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $24.32 / $32.96 / $45.04	Professional	26	$24.32	$32.96	$45.04
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $23.23 / $23.23 / $29.00	Professional	TC	$23.23	$23.23	$29.00
BCBS Facility/Professional Professional Modifier Low / Median / High Price $41.75 / $77.09 / $146.09	Professional		$41.75	$77.09	$146.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.53 / $69.89 / $105.35	Professional		$35.53	$69.89	$105.35
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.51 / $38.40 / $58.38	Professional	26	$23.51	$38.40	$58.38
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $74.87 / $74.87 / $74.87	Professional	50	$74.87	$74.87	$74.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $12.24 / $33.35 / $54.38	Professional	TC	$12.24	$33.35	$54.38
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $65.91 / $101.26 / $187.67	Professional		$65.91	$101.26	$187.67
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.70 / $51.09 / $127.69	Professional	26	$36.70	$51.09	$127.69
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $19.97 / $43.26 / $87.25	Professional	TC	$19.97	$43.26	$87.25
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 $77.56 / $77.59 / $84.66	Professional		$77.56	$77.59	$84.66
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $39.64 / $40.92 / $43.37	Professional	26	$39.64	$40.92	$43.37
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 $32.34 / $39.45 / $88.56	Professional		$32.34	$39.45	$88.56
United Facility/Professional Professional Modifier Low / Median / High Price $33.56 / $58.10 / $103.87	Professional		$33.56	$58.10	$103.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.15 / $29.35 / $46.05	Professional	26	$22.15	$29.35	$46.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $11.43 / $33.20 / $58.06	Professional	TC	$11.43	$33.20	$58.06