Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $102.33 / $138.04	Facility	26	$89.13	$102.33	$138.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $426.58 / $1,000.00	Professional		$194.98	$426.58	$1,000.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $120.23 / $251.19	Professional	26	$66.07	$120.23	$251.19
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $123.03 / $158.49 / $1,698.24	Professional	52	$123.03	$158.49	$1,698.24
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $257.04 / $501.19	Professional	TC	$123.03	$257.04	$501.19
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $338.84 / $758.58	Professional		$208.93	$338.84	$758.58
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $95.50 / $138.04	Professional	26	$72.44	$95.50	$138.04
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $173.78 / $537.03	Professional	TC	$138.04	$173.78	$537.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $141.25 / $141.25 / $141.25	Facility	26	$141.25	$141.25	$141.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $354.81 / $794.33	Professional		$181.97	$354.81	$794.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $87.10 / $173.78	Professional	26	$61.66	$87.10	$173.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $213.80 / $616.60	Professional	TC	$120.23	$213.80	$616.60
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $346.74 / $1,778.28	Professional		$281.84	$346.74	$1,778.28
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $107.15 / $281.84	Professional	26	$97.72	$107.15	$281.84
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $204.17 / $1,479.11	Professional	TC	$186.21	$204.17	$1,479.11
Select Health Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $199.53 / $316.23	Professional		$177.83	$199.53	$316.23
Select Health Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $69.18 / $162.18	Professional	26	$69.18	$69.18	$162.18
Select Health Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $128.82 / $154.88	Professional	TC	$120.23	$128.82	$154.88
United Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $398.11 / $707.95	Professional		$208.93	$398.11	$707.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $102.33 / $190.55	Professional	26	$64.57	$102.33	$190.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $281.84 / $489.78	Professional	TC	$144.54	$281.84	$489.78