Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $120.65 / $120.65 / $161.96	Facility	26	$120.65	$120.65	$161.96
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $157.12 / $157.12 / $157.12	Facility	53	$157.12	$157.12	$157.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $724.24 / $954.60 / $1,286.24	Professional		$724.24	$954.60	$1,286.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $106.99 / $185.71 / $246.97	Professional	26	$106.99	$185.71	$246.97
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $323.49 / $392.81 / $519.00	Professional	52	$323.49	$392.81	$519.00
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $129.40 / $157.12 / $207.60	Professional	53	$129.40	$157.12	$207.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $588.86 / $767.25 / $1,087.32	Professional	TC	$588.86	$767.25	$1,087.32
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $840.11 / $1,104.80 / $1,581.30	Professional		$840.11	$1,104.80	$1,581.30
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $119.31 / $165.26 / $252.40	Professional	26	$119.31	$165.26	$252.40
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $677.46 / $948.52 / $1,354.92	Professional	TC	$677.46	$948.52	$1,354.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $844.41 / $1,185.65 / $1,874.50	Professional		$844.41	$1,185.65	$1,874.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $130.00 / $212.11 / $333.65	Professional	26	$130.00	$212.11	$333.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $674.37 / $994.63 / $1,536.46	Professional	TC	$674.37	$994.63	$1,536.46
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $920.09 / $1,146.57 / $1,557.07	Professional		$920.09	$1,146.57	$1,557.07
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $141.31 / $176.09 / $239.14	Professional	26	$141.31	$176.09	$239.14
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $778.78 / $970.48 / $1,317.93	Professional	TC	$778.78	$970.48	$1,317.93
United Facility/Professional Professional Modifier Low / Median / High Price $925.83 / $1,442.46 / $2,198.75	Professional		$925.83	$1,442.46	$2,198.75
United Facility/Professional Professional Modifier 26 Low / Median / High Price $157.38 / $235.12 / $354.91	Professional	26	$157.38	$235.12	$354.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $747.41 / $1,136.39 / $2,030.15	Professional	TC	$747.41	$1,136.39	$2,030.15