Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.45 / $75.72 / $129.51	Facility	26	$40.45	$75.72	$129.51
Aetna Facility/Professional Professional Modifier Low / Median / High Price $174.69 / $197.83 / $376.25	Professional		$174.69	$197.83	$376.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $136.87 / $157.38 / $300.52	Professional	TC	$136.87	$157.38	$300.52
BCBS Facility/Professional Professional Modifier Low / Median / High Price $54.02 / $193.96 / $451.49	Professional		$54.02	$193.96	$451.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $193.87 / $286.98 / $475.15	Professional		$193.87	$286.98	$475.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $153.80 / $234.87 / $391.21	Professional	TC	$153.80	$234.87	$391.21
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $202.81 / $310.23 / $1,142.14	Professional		$202.81	$310.23	$1,142.14
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $45.29 / $66.41 / $282.57	Professional	26	$45.29	$66.41	$282.57
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $164.73 / $247.02 / $910.47	Professional	TC	$164.73	$247.02	$910.47
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 $239.68 / $245.84 / $265.99	Professional		$239.68	$245.84	$265.99
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $186.41 / $193.73 / $209.89	Professional	TC	$186.41	$193.73	$209.89
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $58.71 / $278.27	Professional		$32.34	$58.71	$278.27
United Facility/Professional Professional Modifier Low / Median / High Price $219.14 / $299.51 / $449.05	Professional		$219.14	$299.51	$449.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $180.72 / $241.45 / $370.11	Professional	TC	$180.72	$241.45	$370.11