Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $107.15 / $138.04 / $169.82	Facility	26	$107.15	$138.04	$169.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $478.63 / $933.25	Professional		$338.84	$478.63	$933.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $120.23 / $239.88	Professional	26	$85.11	$120.23	$239.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $338.84 / $630.96	Professional	TC	$257.04	$338.84	$630.96
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $489.78 / $870.96	Professional		$371.54	$489.78	$870.96
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 50 Low / Median / High Price $501.19 / $616.60 / $1,202.26	Professional	50	$501.19	$616.60	$1,202.26
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $354.81 / $691.83	Professional	TC	$263.03	$354.81	$691.83
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 $323.59 / $537.03 / $1,023.29	Professional		$323.59	$537.03	$1,023.29
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 $245.47 / $416.87 / $794.33	Professional	TC	$245.47	$416.87	$794.33
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $616.60 / $2,344.23	Professional		$501.19	$616.60	$2,344.23
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $131.83 / $398.11	Professional	26	$120.23	$131.83	$398.11
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $380.19 / $416.87 / $1,905.46	Professional	TC	$380.19	$416.87	$1,905.46
Select Health Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $354.81 / $524.81	Professional		$331.13	$354.81	$524.81
Select Health Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $83.18 / $199.53	Professional	26	$83.18	$83.18	$199.53
Select Health Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $269.15 / $323.59	Professional	TC	$251.19	$269.15	$323.59
United Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $575.44 / $977.24	Professional		$371.54	$575.44	$977.24
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 $281.84 / $446.68 / $758.58	Professional	TC	$281.84	$446.68	$758.58