Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $201.76 / $973.00 / $4,634.00	Facility		$201.76	$973.00	$4,634.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.78 / $75.84 / $90.46	Facility	26	$39.78	$75.84	$90.46
Aetna Facility/Professional Professional Modifier Low / Median / High Price $140.13 / $201.76 / $390.65	Professional		$140.13	$201.76	$390.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.78 / $48.19 / $121.62	Professional	26	$39.78	$48.19	$121.62
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $94.17 / $150.08 / $225.12	Professional	TC	$94.17	$150.08	$225.12
BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,097.65 / $2,347.92 / $4,701.70	Facility		$1,097.65	$2,347.92	$4,701.70
BCBS Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $163.35 / $326.31	Professional		$46.77	$163.35	$326.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $173.25 / $240.40 / $311.80	Professional		$173.25	$240.40	$311.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.58 / $61.60 / $91.47	Professional	26	$42.58	$61.60	$91.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $124.76 / $170.20 / $224.41	Professional	TC	$124.76	$170.20	$224.41
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $183.29 / $270.45 / $670.66	Professional		$183.29	$270.45	$670.66
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $44.61 / $68.13 / $198.04	Professional	26	$44.61	$68.13	$198.04
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $137.58 / $201.71 / $472.62	Professional	TC	$137.58	$201.71	$472.62
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 $195.33 / $200.01 / $216.62	Professional		$195.33	$200.01	$216.62
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $46.68 / $49.21 / $52.72	Professional	26	$46.68	$49.21	$52.72
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $146.12 / $153.32 / $163.89	Professional	TC	$146.12	$153.32	$163.89
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.20 / $91.53 / $189.11	Professional		$26.20	$91.53	$189.11
United Facility/Professional Facility Modifier Low / Median / High Price $165.00 / $900.00 / $3,686.00	Facility		$165.00	$900.00	$3,686.00
United Facility/Professional Professional Modifier Low / Median / High Price $148.31 / $235.93 / $363.41	Professional		$148.31	$235.93	$363.41
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.86 / $60.11 / $90.24	Professional	26	$41.86	$60.11	$90.24
United Facility/Professional Professional Modifier TC Low / Median / High Price $103.49 / $172.54 / $299.08	Professional	TC	$103.49	$172.54	$299.08