Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $114.82 / $416.87 / $1,698.24	Facility		$114.82	$416.87	$1,698.24
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.11 / $42.66 / $66.07	Facility	26	$33.11	$42.66	$66.07
Aetna Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $89.13 / $251.19	Professional		$47.86	$89.13	$251.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $53.70 / $123.03	Professional	26	$28.84	$53.70	$123.03
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $56.23 / $144.54 / $537.03	Professional	50	$56.23	$144.54	$537.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $56.23 / $144.54	Professional	TC	$42.66	$56.23	$144.54
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $194.98 / $269.15 / $436.52	Facility		$194.98	$269.15	$436.52
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $125.89 / $177.83	Professional		$91.20	$125.89	$177.83
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $45.71 / $64.57	Professional	26	$33.11	$45.71	$64.57
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $114.82 / $151.36 / $190.55	Professional	50	$114.82	$151.36	$190.55
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $77.62 / $109.65	Professional	TC	$56.23	$77.62	$109.65
Cigna Facility/Professional Facility Modifier Low / Median / High Price $89.13 / $181.97 / $354.81	Facility		$89.13	$181.97	$354.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $102.33 / $204.17	Professional		$77.62	$102.33	$204.17
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $38.90 / $79.43	Professional	26	$28.84	$38.90	$79.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $61.66 / $125.89	Professional	TC	$46.77	$61.66	$125.89
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $144.54 / $489.78	Professional		$123.03	$144.54	$489.78
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $52.48 / $186.21	Professional	26	$45.71	$52.48	$186.21
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $91.20 / $302.00	Professional	TC	$79.43	$91.20	$302.00
Select Health Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $87.10 / $131.83	Professional		$85.11	$87.10	$131.83
Select Health Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $31.62 / $51.29	Professional	26	$31.62	$31.62	$51.29
Select Health Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $54.95 / $79.43	Professional	TC	$53.70	$54.95	$79.43
United Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $114.82 / $190.55	Professional		$89.13	$114.82	$190.55
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $44.67 / $74.13	Professional	26	$34.67	$44.67	$74.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $70.79 / $117.49	Professional	TC	$54.95	$70.79	$117.49