Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $91.99 / $91.99 / $91.99	Facility	26	$91.99	$91.99	$91.99
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $126.78 / $126.78 / $126.78	Facility	53	$126.78	$126.78	$126.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $633.95 / $954.60 / $3,537.00	Professional		$633.95	$954.60	$3,537.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $91.99 / $187.33 / $353.34	Professional	26	$91.99	$187.33	$353.34
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $316.95 / $435.54 / $435.54	Professional	52	$316.95	$435.54	$435.54
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $126.78 / $174.21 / $174.21	Professional	53	$126.78	$174.21	$174.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $541.90 / $767.25 / $1,108.33	Professional	TC	$541.90	$767.25	$1,108.33
BCBS Facility/Professional Professional Modifier Low / Median / High Price $103.70 / $493.56 / $1,377.03	Professional		$103.70	$493.56	$1,377.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $731.22 / $1,098.10 / $1,641.90	Professional		$731.22	$1,098.10	$1,641.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $116.51 / $222.82 / $318.89	Professional	26	$116.51	$222.82	$318.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $621.29 / $855.92 / $1,307.11	Professional	TC	$621.29	$855.92	$1,307.11
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $188.35 / $987.85	Professional		$32.34	$188.35	$987.85
Providence Facility/Professional Professional Modifier Low / Median / High Price $878.49 / $1,395.24 / $1,938.52	Professional		$878.49	$1,395.24	$1,938.52
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $134.10 / $222.82 / $329.38	Professional	26	$134.10	$222.82	$329.38
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $654.61 / $855.92 / $1,214.97	Professional	TC	$654.61	$855.92	$1,214.97
United Facility/Professional Professional Modifier Low / Median / High Price $879.50 / $1,381.00 / $2,031.92	Professional		$879.50	$1,381.00	$2,031.92
United Facility/Professional Professional Modifier 26 Low / Median / High Price $135.41 / $259.87 / $348.00	Professional	26	$135.41	$259.87	$348.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $747.41 / $1,136.39 / $1,752.30	Professional	TC	$747.41	$1,136.39	$1,752.30