Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $108.81 / $546.00 / $822.59	Facility		$108.81	$546.00	$822.59
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $88.50 / $88.50 / $88.50	Facility	26	$88.50	$88.50	$88.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.34 / $152.77 / $468.15	Professional		$107.34	$152.77	$468.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.07 / $41.47 / $135.00	Professional	26	$24.07	$41.47	$135.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $62.77 / $81.96 / $337.21	Professional	52	$62.77	$81.96	$337.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $83.28 / $103.70 / $236.28	Professional	TC	$83.28	$103.70	$236.28
BCBS Facility/Professional Facility Modifier Low / Median / High Price $842.00 / $77,999.99 / $94,999.99	Facility		$842.00	$77,999.99	$94,999.99
BCBS Facility/Professional Professional Modifier Low / Median / High Price $41.54 / $41.54 / $174.04	Professional		$41.54	$41.54	$174.04
Cigna Facility/Professional Facility Modifier Low / Median / High Price $133.88 / $182.96 / $508.73	Facility		$133.88	$182.96	$508.73
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.54 / $41.54 / $51.35	Facility	26	$41.54	$41.54	$51.35
Cigna Facility/Professional Professional Modifier Low / Median / High Price $94.91 / $174.04 / $251.76	Professional		$94.91	$174.04	$251.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.44 / $41.54 / $58.68	Professional	26	$28.44	$41.54	$58.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $62.91 / $132.50 / $195.14	Professional	TC	$62.91	$132.50	$195.14
Providence Facility/Professional Facility Modifier Low / Median / High Price $106.06 / $180.73 / $263.73	Facility		$106.06	$180.73	$263.73
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $41.54 / $41.54 / $51.35	Facility	26	$41.54	$41.54	$51.35
Providence Facility/Professional Professional Modifier Low / Median / High Price $115.97 / $190.90 / $302.79	Professional		$115.97	$190.90	$302.79
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $33.20 / $41.54 / $47.91	Professional	26	$33.20	$41.54	$47.91
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $86.77 / $132.50 / $156.84	Professional	TC	$86.77	$132.50	$156.84
United Facility/Professional Facility Modifier Low / Median / High Price $143.63 / $143.63 / $143.63	Facility		$143.63	$143.63	$143.63
United Facility/Professional Professional Modifier Low / Median / High Price $110.99 / $118.01 / $199.47	Professional		$110.99	$118.01	$199.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.39 / $28.87 / $50.70	Professional	26	$28.39	$28.87	$50.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $82.60 / $89.16 / $156.55	Professional	TC	$82.60	$89.16	$156.55