Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $43.65 / $117.49 / $645.65	Facility		$43.65	$117.49	$645.65
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.96 / $14.13 / $18.20	Facility	26	$10.96	$14.13	$18.20
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $33.11 / $74.13 / $245.47	Facility	TC	$33.11	$74.13	$245.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $43.65 / $109.65	Professional		$33.11	$43.65	$109.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $12.88 / $36.31	Professional	26	$8.91	$12.88	$36.31
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $26.92 / $147.91 / $204.17	Professional	50	$26.92	$147.91	$204.17
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $17.78 / $17.78 / $17.78	Professional	52	$17.78	$17.78	$17.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $32.36 / $66.07	Professional	TC	$22.91	$32.36	$66.07
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $134.90 / $218.78	Facility		$100.00	$134.90	$218.78
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $56.23 / $85.11	Professional		$38.90	$56.23	$85.11
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $14.13 / $20.89	Professional	26	$10.96	$14.13	$20.89
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $53.70 / $57.54 / $75.86	Professional	50	$53.70	$57.54	$75.86
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $42.66 / $63.10	Professional	TC	$26.30	$42.66	$63.10
Cigna Facility/Professional Facility Modifier Low / Median / High Price $41.69 / $208.93 / $426.58	Facility		$41.69	$208.93	$426.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $48.98 / $87.10	Professional		$34.67	$48.98	$87.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.77 / $13.80 / $25.12	Professional	26	$9.77	$13.80	$25.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $34.67 / $63.10	Professional	TC	$25.12	$34.67	$63.10
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $69.18 / $162.18	Professional		$61.66	$69.18	$162.18
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $16.98 / $48.98	Professional	26	$15.49	$16.98	$48.98
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $51.29 / $114.82	Professional	TC	$46.77	$51.29	$114.82
Select Health Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $43.65 / $63.10	Professional		$39.81	$43.65	$63.10
Select Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $10.96 / $16.98	Professional	26	$10.47	$10.96	$16.98
Select Health Facility/Professional Professional Modifier 50 Low / Median / High Price $141.25 / $141.25 / $141.25	Professional	50	$141.25	$141.25	$141.25
Select Health Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $33.11 / $46.77	Professional	TC	$28.84	$33.11	$46.77
United Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $52.48 / $85.11	Professional		$38.02	$52.48	$85.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $15.14 / $25.12	Professional	26	$11.22	$15.14	$25.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $38.02 / $61.66	Professional	TC	$26.30	$38.02	$61.66