Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.02 / $16.98 / $21.38	Facility	26	$12.02	$16.98	$21.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $112.20 / $269.15	Professional		$70.79	$112.20	$269.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $19.05 / $47.86	Professional	26	$10.96	$19.05	$47.86
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $24.55 / $35.48 / $371.54	Professional	52	$24.55	$35.48	$371.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $91.20 / $173.78	Professional	TC	$63.10	$91.20	$173.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $66.07 / $97.72	Professional		$52.48	$66.07	$97.72
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $11.22 / $17.78	Professional	26	$8.51	$11.22	$17.78
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $13.18 / $15.85 / $19.50	Professional	52	$13.18	$15.85	$19.50
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $47.86 / $51.29	Professional	TC	$44.67	$47.86	$51.29
BCBS Facility/Professional Professional Modifier Low / Median / High Price $13.80 / $69.18 / $144.54	Professional		$13.80	$69.18	$144.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $114.82 / $194.98	Professional		$79.43	$114.82	$194.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $16.60 / $26.92	Professional	26	$11.75	$16.60	$26.92
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $102.33 / $169.82	Professional	TC	$69.18	$102.33	$169.82
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $134.90 / $144.54	Professional		$85.11	$134.90	$144.54
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $20.89 / $128.82	Professional	26	$13.49	$20.89	$128.82
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $87.10 / $138.04	Professional	TC	$50.12	$87.10	$138.04
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 $95.50 / $97.72 / $107.15	Professional		$95.50	$97.72	$107.15
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $14.79 / $16.22	Professional	26	$13.80	$14.79	$16.22
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $83.18 / $91.20	Professional	TC	$81.28	$83.18	$91.20
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 $83.18 / $112.20 / $181.97	Professional		$83.18	$112.20	$181.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $15.49 / $24.55	Professional	26	$11.75	$15.49	$24.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $97.72 / $162.18	Professional	TC	$69.18	$97.72	$162.18