Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $107.15 / $107.15 / $169.82	Facility	26	$107.15	$107.15	$169.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $426.58 / $870.96	Professional		$275.42	$426.58	$870.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $131.83 / $288.40	Professional	26	$85.11	$131.83	$288.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $302.00 / $501.19	Professional	TC	$190.55	$302.00	$501.19
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $446.68 / $812.83	Professional		$295.12	$446.68	$812.83
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $114.82 / $165.96	Professional	26	$87.10	$114.82	$165.96
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $263.03 / $602.56	Professional	TC	$208.93	$263.03	$602.56
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $169.82 / $169.82 / $169.82	Facility	26	$169.82	$169.82	$169.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $478.63 / $977.24	Professional		$257.04	$478.63	$977.24
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $104.71 / $199.53	Professional	26	$72.44	$104.71	$199.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $323.59 / $776.25	Professional	TC	$181.97	$323.59	$776.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $489.78 / $2,570.40	Professional		$398.11	$489.78	$2,570.40
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $131.83 / $380.19	Professional	26	$117.49	$131.83	$380.19
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $309.03 / $2,187.76	Professional	TC	$281.84	$309.03	$2,187.76
Select Health Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $281.84 / $436.52	Professional		$251.19	$281.84	$436.52
Select Health Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $83.18 / $194.98	Professional	26	$83.18	$83.18	$194.98
Select Health Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $199.53 / $239.88	Professional	TC	$186.21	$199.53	$239.88
United Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $537.03 / $933.25	Professional		$302.00	$537.03	$933.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $117.49 / $218.78	Professional	26	$74.13	$117.49	$218.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $407.38 / $676.08	Professional	TC	$208.93	$407.38	$676.08