Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $676.20 / $676.20 / $676.20	Facility		$676.20	$676.20	$676.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $144.78 / $187.84 / $649.00	Professional		$144.78	$187.84	$649.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.03 / $23.55 / $49.32	Professional	26	$21.03	$23.55	$49.32
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $72.39 / $87.09 / $357.34	Professional	52	$72.39	$87.09	$357.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $147.36 / $164.30 / $271.43	Professional	TC	$147.36	$164.30	$271.43
BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,089.27 / $77,999.99 / $94,999.99	Facility		$1,089.27	$77,999.99	$94,999.99
BCBS Facility/Professional Professional Modifier Low / Median / High Price $33.65 / $33.65 / $205.59	Professional		$33.65	$33.65	$205.59
Cigna Facility/Professional Facility Modifier Low / Median / High Price $168.69 / $244.38 / $641.02	Facility		$168.69	$244.38	$641.02
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.65 / $33.65 / $40.00	Facility	26	$33.65	$33.65	$40.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $163.09 / $205.59 / $284.66	Professional		$163.09	$205.59	$284.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.82 / $33.65 / $47.88	Professional	26	$22.82	$33.65	$47.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $137.07 / $171.94 / $236.78	Professional	TC	$137.07	$171.94	$236.78
Providence Facility/Professional Facility Modifier Low / Median / High Price $168.69 / $285.56 / $335.69	Facility		$168.69	$285.56	$335.69
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $33.65 / $33.65 / $40.00	Facility	26	$33.65	$33.65	$40.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $134.59 / $228.14 / $345.02	Professional		$134.59	$228.14	$345.02
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $22.86 / $33.65 / $37.28	Professional	26	$22.86	$33.65	$37.28
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $137.07 / $171.94 / $202.79	Professional	TC	$137.07	$171.94	$202.79
United Facility/Professional Professional Modifier Low / Median / High Price $190.75 / $216.93 / $301.83	Professional		$190.75	$216.93	$301.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.93 / $36.54 / $40.96	Professional	26	$30.93	$36.54	$40.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $156.81 / $183.49 / $276.48	Professional	TC	$156.81	$183.49	$276.48