Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $14.45 / $21.88	Facility	26	$11.48	$14.45	$21.88
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $38.90 / $229.09 / $537.03	Facility	TC	$38.90	$229.09	$537.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $22.39 / $52.48 / $165.96	Professional		$22.39	$52.48	$165.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $21.38 / $58.88	Professional	26	$10.00	$21.38	$58.88
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $41.69 / $123.03 / $302.00	Professional	50	$41.69	$123.03	$302.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $43.65 / $43.65 / $43.65	Professional	52	$43.65	$43.65	$43.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $44.67 / $91.20	Professional	TC	$28.18	$44.67	$91.20
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $63.10 / $95.50	Professional		$40.74	$63.10	$95.50
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $14.79 / $21.38	Professional	26	$11.22	$14.79	$21.38
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $51.29 / $61.66 / $87.10	Professional	50	$51.29	$61.66	$87.10
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $47.86 / $72.44	Professional	TC	$28.84	$47.86	$72.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $51.29 / $97.72	Professional		$34.67	$51.29	$97.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.77 / $14.13 / $26.30	Professional	26	$9.77	$14.13	$26.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $37.15 / $72.44	Professional	TC	$24.55	$37.15	$72.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $81.28 / $186.21	Professional		$61.66	$81.28	$186.21
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $17.38 / $58.88	Professional	26	$15.85	$17.38	$58.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $63.10 / $128.82	Professional	TC	$57.54	$63.10	$128.82
Select Health Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $52.48 / $72.44	Professional		$45.71	$52.48	$72.44
Select Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $11.22 / $17.38	Professional	26	$10.96	$11.22	$17.38
Select Health Facility/Professional Professional Modifier 50 Low / Median / High Price $177.83 / $177.83 / $177.83	Professional	50	$177.83	$177.83	$177.83
Select Health Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $40.74 / $54.95	Professional	TC	$33.88	$40.74	$54.95
United Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $57.54 / $93.33	Professional		$38.02	$57.54	$93.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $14.79 / $24.55	Professional	26	$10.23	$14.79	$24.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $42.66 / $70.79	Professional	TC	$27.54	$42.66	$70.79