Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $79.43 / $102.33	Professional		$67.61	$79.43	$102.33
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $19.05 / $29.51	Professional	26	$19.05	$19.05	$29.51
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $89.13 / $416.87	Professional		$60.26	$89.13	$416.87
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $26.92 / $302.00	Professional	26	$19.05	$26.92	$302.00
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $64.57 / $302.00	Professional	TC	$48.98	$64.57	$302.00
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 $89.13 / $91.20 / $97.72	Professional		$89.13	$91.20	$97.72
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $25.70 / $27.54	Professional	26	$25.12	$25.70	$27.54
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $66.07 / $70.79	Professional	TC	$63.10	$66.07	$70.79
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 $75.86 / $109.65 / $186.21	Professional		$75.86	$109.65	$186.21
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $24.55 / $37.15	Professional	26	$19.50	$24.55	$37.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $83.18 / $141.25	Professional	TC	$54.95	$83.18	$141.25