Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.69 / $36.22 / $50.40	Facility	26	$25.69	$36.22	$50.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $45.50 / $58.31 / $200.00	Professional		$45.50	$58.31	$200.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.77 / $37.40 / $115.07	Professional	26	$25.77	$37.40	$115.07
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $31.53 / $68.23 / $261.44	Professional	52	$31.53	$68.23	$261.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.80 / $25.32 / $47.25	Professional	TC	$19.80	$25.32	$47.25
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $37.14 / $44.61 / $68.23	Professional		$37.14	$44.61	$68.23
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $20.72 / $26.44 / $38.85	Professional	26	$20.72	$26.44	$38.85
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $9.47 / $12.78 / $13.42	Professional	52	$9.47	$12.78	$13.42
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $27.91 / $32.95	Professional	TC	$20.42	$27.91	$32.95
BCBS Facility/Professional Professional Modifier Low / Median / High Price $28.03 / $48.48 / $54.14	Professional		$28.03	$48.48	$54.14
Cigna Facility/Professional Professional Modifier Low / Median / High Price $43.43 / $71.02 / $104.52	Professional		$43.43	$71.02	$104.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.36 / $38.86 / $59.92	Professional	26	$24.36	$38.86	$59.92
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.04 / $32.15 / $50.07	Professional	TC	$20.04	$32.15	$50.07
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $61.81 / $89.44 / $301.64	Professional		$61.81	$89.44	$301.64
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $34.04 / $49.03 / $190.70	Professional	26	$34.04	$49.03	$190.70
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $26.21 / $39.79 / $154.83	Professional	TC	$26.21	$39.79	$154.83
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 $63.02 / $63.48 / $68.39	Professional		$63.02	$63.48	$68.39
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $34.50 / $35.40 / $37.40	Professional	26	$34.50	$35.40	$37.40
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $27.61 / $28.98 / $30.98	Professional	TC	$27.61	$28.98	$30.98
Molina Facility/Professional Professional Modifier Low / Median / High Price $29.74 / $32.34 / $71.55	Professional		$29.74	$32.34	$71.55
United Facility/Professional Professional Modifier Low / Median / High Price $55.68 / $76.42 / $114.26	Professional		$55.68	$76.42	$114.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.55 / $38.90 / $56.18	Professional	26	$30.55	$38.90	$56.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.94 / $31.19 / $46.28	Professional	TC	$24.94	$31.19	$46.28