Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $221.00 / $297.39 / $398.72	Facility		$221.00	$297.39	$398.72
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $378.29 / $378.29 / $426.97	Facility	TC	$378.29	$378.29	$426.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $35.95 / $40.22 / $163.12	Professional		$35.95	$40.22	$163.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.36 / $11.15 / $34.20	Professional	26	$10.36	$11.15	$34.20
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $23.40 / $38.29 / $38.29	Professional	50	$23.40	$38.29	$38.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.57 / $27.76 / $53.05	Professional	TC	$25.57	$27.76	$53.05
BCBS Facility/Professional Facility Modifier Low / Median / High Price $247.27 / $77,999.99 / $94,999.99	Facility		$247.27	$77,999.99	$94,999.99
BCBS Facility/Professional Professional Modifier Low / Median / High Price $16.82 / $16.82 / $65.20	Professional		$16.82	$16.82	$65.20
Cigna Facility/Professional Facility Modifier Low / Median / High Price $49.27 / $65.20 / $85.64	Facility		$49.27	$65.20	$85.64
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.82 / $16.82 / $20.80	Facility	26	$16.82	$16.82	$20.80
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $48.37 / $48.37 / $59.80	Facility	TC	$48.37	$48.37	$59.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $40.17 / $53.92 / $88.91	Professional		$40.17	$53.92	$88.91
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.46 / $15.44 / $26.30	Professional	26	$12.46	$15.44	$26.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.71 / $39.04 / $61.35	Professional	TC	$27.71	$39.04	$61.35
Providence Facility/Professional Facility Modifier Low / Median / High Price $39.46 / $58.68 / $85.64	Facility		$39.46	$58.68	$85.64
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $16.82 / $16.82 / $20.80	Facility	26	$16.82	$16.82	$20.80
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $48.37 / $48.37 / $59.80	Facility	TC	$48.37	$48.37	$59.80
Providence Facility/Professional Professional Modifier Low / Median / High Price $40.13 / $65.20 / $103.91	Professional		$40.13	$65.20	$103.91
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $12.46 / $16.82 / $22.68	Professional	26	$12.46	$16.82	$22.68
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $27.71 / $45.94 / $53.52	Professional	TC	$27.71	$45.94	$53.52
United Facility/Professional Professional Modifier Low / Median / High Price $39.74 / $40.93 / $70.98	Professional		$39.74	$40.93	$70.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.55 / $12.17 / $20.28	Professional	26	$11.55	$12.17	$20.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.92 / $28.87 / $50.70	Professional	TC	$27.92	$28.87	$50.70