Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $54.95 / $81.28 / $891.25	Facility		$54.95	$81.28	$891.25
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.92 / $40.74 / $46.77	Facility	26	$26.92	$40.74	$46.77
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $27.54 / $41.69 / $977.24	Facility	TC	$27.54	$41.69	$977.24
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $154.88 / $891.25	Professional		$53.70	$154.88	$891.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $213.80 / $912.01	Professional	26	$33.88	$213.80	$912.01
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $51.29 / $165.96	Professional	TC	$21.88	$51.29	$165.96
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $74.13 / $151.36	Professional		$74.13	$74.13	$151.36
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $37.15 / $75.86	Professional	26	$37.15	$37.15	$75.86
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $37.15 / $75.86	Professional	TC	$37.15	$37.15	$75.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $63.10 / $138.04	Professional		$33.11	$63.10	$138.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $30.90 / $87.10	Professional	26	$16.60	$30.90	$87.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $28.84 / $83.18	Professional	TC	$15.14	$28.84	$83.18
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $102.33 / $102.33	Professional		$102.33	$102.33	$102.33
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $50.12 / $50.12	Professional	26	$50.12	$50.12	$50.12
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $52.48 / $52.48	Professional	TC	$52.48	$52.48	$52.48
Select Health Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $72.44 / $117.49	Professional		$66.07	$72.44	$117.49
Select Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $36.31 / $64.57	Professional	26	$33.88	$36.31	$64.57
Select Health Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $37.15 / $57.54	Professional	TC	$32.36	$37.15	$57.54
United Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $61.66 / $162.18	Professional		$42.66	$61.66	$162.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $23.99 / $77.62	Professional	26	$21.38	$23.99	$77.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $39.81 / $74.13	Professional	TC	$19.05	$39.81	$74.13