Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $559.76 / $1,181.00 / $5,091.00	Facility		$559.76	$1,181.00	$5,091.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $125.70 / $237.77 / $290.22	Facility	26	$125.70	$237.77	$290.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $368.38 / $455.15 / $753.92	Professional		$368.38	$455.15	$753.92
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $125.70 / $146.19 / $246.88	Professional	26	$125.70	$146.19	$246.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $237.40 / $261.14 / $392.01	Professional	TC	$237.40	$261.14	$392.01
BCBS Facility/Professional Facility Modifier Low / Median / High Price $869.72 / $3,101.12 / $7,214.15	Facility		$869.72	$3,101.12	$7,214.15
BCBS Facility/Professional Professional Modifier Low / Median / High Price $151.25 / $376.76 / $715.10	Professional		$151.25	$376.76	$715.10
Cigna Facility/Professional Facility Modifier Low / Median / High Price $875.00 / $875.00 / $908.00	Facility		$875.00	$875.00	$908.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $356.79 / $507.18 / $698.10	Professional		$356.79	$507.18	$698.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $134.78 / $182.14 / $260.27	Professional	26	$134.78	$182.14	$260.27
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $213.76 / $327.02 / $443.82	Professional	TC	$213.76	$327.02	$443.82
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $362.20 / $576.22 / $1,489.73	Professional		$362.20	$576.22	$1,489.73
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $143.69 / $206.43 / $383.85	Professional	26	$143.69	$206.43	$383.85
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $254.40 / $361.77 / $683.72	Professional	TC	$254.40	$361.77	$683.72
Hally Health Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $100.00 / $100.00	Facility		$100.00	$100.00	$100.00
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 $428.05 / $429.39 / $474.15	Professional		$428.05	$429.39	$474.15
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $144.91 / $147.28 / $170.48	Professional	26	$144.91	$147.28	$170.48
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $258.12 / $270.19 / $303.67	Professional	TC	$258.12	$270.19	$303.67
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $192.78 / $536.15	Professional		$32.34	$192.78	$536.15
United Facility/Professional Facility Modifier Low / Median / High Price $553.00 / $1,763.00 / $4,342.00	Facility		$553.00	$1,763.00	$4,342.00
United Facility/Professional Professional Modifier Low / Median / High Price $350.04 / $535.58 / $836.58	Professional		$350.04	$535.58	$836.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $134.44 / $189.41 / $282.25	Professional	26	$134.44	$189.41	$282.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $217.77 / $328.88 / $565.72	Professional	TC	$217.77	$328.88	$565.72