Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $106.34 / $421.20 / $682.50	Facility		$106.34	$421.20	$682.50
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $296.58 / $427.57 / $427.57	Facility	TC	$296.58	$427.57	$427.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $119.64 / $146.49 / $587.92	Professional		$119.64	$146.49	$587.92
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.86 / $48.46 / $157.63	Professional	26	$32.86	$48.46	$157.63
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $60.94 / $78.88 / $328.05	Professional	52	$60.94	$78.88	$328.05
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $87.95 / $104.87 / $189.14	Professional	TC	$87.95	$104.87	$189.14
BCBS Facility/Professional Facility Modifier Low / Median / High Price $728.40 / $77,999.99 / $94,999.99	Facility		$728.40	$77,999.99	$94,999.99
BCBS Facility/Professional Professional Modifier Low / Median / High Price $54.68 / $54.68 / $170.89	Professional		$54.68	$54.68	$170.89
Cigna Facility/Professional Facility Modifier Low / Median / High Price $116.55 / $170.89 / $442.89	Facility		$116.55	$170.89	$442.89
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.68 / $54.68 / $67.59	Facility	26	$54.68	$54.68	$67.59
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $116.20 / $116.20 / $143.65	Facility	TC	$116.20	$116.20	$143.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $119.80 / $170.89 / $246.61	Professional		$119.80	$170.89	$246.61
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.34 / $54.68 / $76.97	Professional	26	$37.34	$54.68	$76.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $80.54 / $116.20 / $169.63	Professional	TC	$80.54	$116.20	$169.63
Providence Facility/Professional Facility Modifier Low / Median / High Price $109.06 / $204.27 / $249.21	Facility		$109.06	$204.27	$249.21
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $54.68 / $54.68 / $67.59	Facility	26	$54.68	$54.68	$67.59
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $116.20 / $116.20 / $143.65	Facility	TC	$116.20	$116.20	$143.65
Providence Facility/Professional Professional Modifier Low / Median / High Price $114.61 / $185.66 / $304.00	Professional		$114.61	$185.66	$304.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $43.56 / $54.68 / $62.96	Professional	26	$43.56	$54.68	$62.96
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $87.13 / $116.20 / $135.66	Professional	TC	$87.13	$116.20	$135.66
United Facility/Professional Professional Modifier Low / Median / High Price $115.13 / $128.69 / $202.19	Professional		$115.13	$128.69	$202.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.53 / $37.59 / $65.91	Professional	26	$37.53	$37.59	$65.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.59 / $90.71 / $136.28	Professional	TC	$77.59	$90.71	$136.28