Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $403.75 / $403.75 / $403.75	Facility	26	$403.75	$403.75	$403.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $126.23 / $247.93 / $802.00	Professional		$126.23	$247.93	$802.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.89 / $54.53 / $201.04	Professional	26	$46.89	$54.53	$201.04
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $63.12 / $81.52 / $456.88	Professional	52	$63.12	$81.52	$456.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $91.32 / $201.03 / $401.61	Professional	TC	$91.32	$201.03	$401.61
BCBS Facility/Professional Professional Modifier Low / Median / High Price $79.92 / $79.92 / $215.05	Professional		$79.92	$79.92	$215.05
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.92 / $79.92 / $98.80	Facility	26	$79.92	$79.92	$98.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $197.64 / $293.33 / $371.88	Professional		$197.64	$293.33	$371.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.30 / $75.84 / $135.07	Professional	26	$55.30	$75.84	$135.07
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $135.13 / $208.94 / $268.64	Professional	TC	$135.13	$208.94	$268.64
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $79.92 / $79.92 / $98.80	Facility	26	$79.92	$79.92	$98.80
Providence Facility/Professional Professional Modifier Low / Median / High Price $144.06 / $235.60 / $354.40	Professional		$144.06	$235.60	$354.40
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $55.30 / $79.92 / $99.29	Professional	26	$55.30	$79.92	$99.29
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $135.13 / $172.93 / $223.63	Professional	TC	$135.13	$172.93	$223.63
United Facility/Professional Professional Modifier Low / Median / High Price $136.51 / $219.08 / $282.04	Professional		$136.51	$219.08	$282.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.43 / $51.09 / $103.95	Professional	26	$44.43	$51.09	$103.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $86.20 / $160.16 / $235.10	Professional	TC	$86.20	$160.16	$235.10