Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $130.41 / $130.41 / $130.41	Facility	26	$130.41	$130.41	$130.41
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $175.53 / $175.53 / $175.53	Facility	53	$175.53	$175.53	$175.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $695.73 / $877.64 / $1,191.97	Professional		$695.73	$877.64	$1,191.97
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $106.87 / $173.18 / $269.43	Professional	26	$106.87	$173.18	$269.43
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $335.54 / $422.27 / $505.27	Professional	52	$335.54	$422.27	$505.27
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $134.22 / $168.91 / $202.11	Professional	53	$134.22	$168.91	$202.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $588.86 / $747.23 / $1,175.16	Professional	TC	$588.86	$747.23	$1,175.16
BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,373.57 / $1,695.08 / $1,815.36	Professional		$1,373.57	$1,695.08	$1,815.36
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $216.98 / $267.77 / $279.88	Professional	26	$216.98	$267.77	$279.88
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $1,156.58 / $1,427.31 / $1,541.81	Professional	TC	$1,156.58	$1,427.31	$1,541.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $126.71 / $126.71 / $126.71	Facility	26	$126.71	$126.71	$126.71
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $163.30 / $163.30 / $163.30	Facility	53	$163.30	$163.30	$163.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $865.44 / $1,391.96 / $2,246.88	Professional		$865.44	$1,391.96	$2,246.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $135.43 / $232.93 / $369.82	Professional	26	$135.43	$232.93	$369.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $699.89 / $1,176.77 / $1,899.83	Professional	TC	$699.89	$1,176.77	$1,899.83
Medica Facility/Professional Professional Modifier Low / Median / High Price $967.45 / $1,842.16 / $5,332.25	Professional		$967.45	$1,842.16	$5,332.25
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $156.60 / $291.14 / $1,044.83	Professional	26	$156.60	$291.14	$1,044.83
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $796.59 / $1,485.51 / $4,416.72	Professional	TC	$796.59	$1,485.51	$4,416.72
United Facility/Professional Professional Modifier Low / Median / High Price $879.50 / $1,735.40 / $2,104.75	Professional		$879.50	$1,735.40	$2,104.75
United Facility/Professional Professional Modifier 26 Low / Median / High Price $170.56 / $279.08 / $442.56	Professional	26	$170.56	$279.08	$442.56
United Facility/Professional Professional Modifier TC Low / Median / High Price $747.41 / $1,407.33 / $1,795.02	Professional	TC	$747.41	$1,407.33	$1,795.02