Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $134.90 / $630.96 / $1,318.26	Facility		$134.90	$630.96	$1,318.26
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.48 / $46.77 / $85.11	Facility	26	$35.48	$46.77	$85.11
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $77.62 / $416.87 / $870.96	Facility	TC	$77.62	$416.87	$870.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $134.90 / $354.81	Professional		$89.13	$134.90	$354.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $46.77 / $128.82	Professional	26	$30.90	$46.77	$128.82
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $181.97 / $181.97 / $181.97	Professional	52	$181.97	$181.97	$181.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $83.18 / $204.17	Professional	TC	$60.26	$83.18	$204.17
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $251.19 / $346.74 / $549.54	Facility		$251.19	$346.74	$549.54
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $158.49 / $229.09	Professional		$114.82	$158.49	$229.09
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $50.12 / $69.18	Professional	26	$37.15	$50.12	$69.18
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $109.65 / $154.88	Professional	TC	$79.43	$109.65	$154.88
Cigna Facility/Professional Facility Modifier Low / Median / High Price $117.49 / $223.87 / $426.58	Facility		$117.49	$223.87	$426.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $134.90 / $288.40	Professional		$102.33	$134.90	$288.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $41.69 / $87.10	Professional	26	$31.62	$41.69	$87.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $93.33 / $199.53	Professional	TC	$70.79	$93.33	$199.53
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $181.97 / $588.84	Professional		$158.49	$181.97	$588.84
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $57.54 / $194.98	Professional	26	$48.98	$57.54	$194.98
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $125.89 / $389.05	Professional	TC	$109.65	$125.89	$389.05
Select Health Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $112.20 / $165.96	Professional		$109.65	$112.20	$165.96
Select Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $34.67 / $54.95	Professional	26	$33.88	$34.67	$54.95
Select Health Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $75.86 / $107.15	Professional	TC	$74.13	$75.86	$107.15
United Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $151.36 / $251.19	Professional		$114.82	$151.36	$251.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $47.86 / $79.43	Professional	26	$37.15	$47.86	$79.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $102.33 / $169.82	Professional	TC	$77.62	$102.33	$169.82