Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.59 / $17.39 / $21.07	Facility	26	$11.59	$17.39	$21.07
Aetna Facility/Professional Professional Modifier Low / Median / High Price $49.85 / $57.89 / $119.38	Professional		$49.85	$57.89	$119.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.13 / $14.23 / $51.09	Professional	26	$11.13	$14.23	$51.09
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $23.82 / $27.42 / $37.61	Professional	52	$23.82	$27.42	$37.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $38.52 / $44.17 / $68.45	Professional	TC	$38.52	$44.17	$68.45
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $48.04 / $55.28 / $69.01	Professional		$48.04	$55.28	$69.01
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.14 / $12.36 / $15.89	Professional	26	$10.14	$12.36	$15.89
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $37.65 / $49.98 / $57.48	Professional	TC	$37.65	$49.98	$57.48
BCBS Facility/Professional Professional Modifier Low / Median / High Price $13.05 / $43.09 / $97.65	Professional		$13.05	$43.09	$97.65
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.55 / $13.55 / $13.55	Facility	26	$13.55	$13.55	$13.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $54.14 / $76.42 / $110.11	Professional		$54.14	$76.42	$110.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.99 / $16.36 / $25.82	Professional	26	$11.99	$16.36	$25.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $42.18 / $58.91 / $84.86	Professional	TC	$42.18	$58.91	$84.86
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $56.49 / $82.48 / $315.41	Professional		$56.49	$82.48	$315.41
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $17.51 / $71.91	Professional	26	$12.02	$17.51	$71.91
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $42.68 / $61.18 / $183.47	Professional	TC	$42.68	$61.18	$183.47
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 $66.76 / $68.09 / $74.20	Professional		$66.76	$68.09	$74.20
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.29 / $14.59 / $15.30	Professional	26	$14.29	$14.59	$15.30
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $50.08 / $52.17 / $58.92	Professional	TC	$50.08	$52.17	$58.92
Molina Facility/Professional Professional Modifier Low / Median / High Price $16.01 / $32.34 / $77.63	Professional		$16.01	$32.34	$77.63
United Facility/Professional Professional Modifier Low / Median / High Price $50.17 / $75.90 / $121.58	Professional		$50.17	$75.90	$121.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.28 / $15.16 / $25.07	Professional	26	$11.28	$15.16	$25.07
United Facility/Professional Professional Modifier TC Low / Median / High Price $37.33 / $51.80 / $84.52	Professional	TC	$37.33	$51.80	$84.52