Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $144.54 / $186.21 / $323.59	Facility		$144.54	$186.21	$323.59
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.91 / $28.84 / $63.10	Facility	26	$22.91	$28.84	$63.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $154.88 / $363.08	Professional		$112.20	$154.88	$363.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $28.18 / $69.18	Professional	26	$19.95	$28.18	$69.18
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $123.03 / $123.03 / $123.03	Professional	52	$123.03	$123.03	$123.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $123.03 / $257.04	Professional	TC	$97.72	$123.03	$257.04
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $134.90 / $181.97	Professional		$134.90	$134.90	$181.97
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $21.88 / $30.90	Professional	26	$21.88	$21.88	$30.90
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $114.82 / $158.49	Professional	TC	$114.82	$114.82	$158.49
Cigna Facility/Professional Facility Modifier Low / Median / High Price $117.49 / $323.59 / $630.96	Facility		$117.49	$323.59	$630.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $204.17 / $338.84	Professional		$138.04	$204.17	$338.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $30.90 / $57.54	Professional	26	$22.39	$30.90	$57.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $173.78 / $281.84	Professional	TC	$117.49	$173.78	$281.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $218.78 / $407.38	Professional		$199.53	$218.78	$407.38
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $33.11 / $52.48	Professional	26	$25.70	$33.11	$52.48
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $181.97 / $354.81	Professional	TC	$169.82	$181.97	$354.81
Select Health Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $141.25 / $229.09	Professional		$131.83	$141.25	$229.09
Select Health Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $21.38 / $38.90	Professional	26	$20.42	$21.38	$38.90
Select Health Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $120.23 / $190.55	Professional	TC	$109.65	$120.23	$190.55
United Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $204.17 / $309.03	Professional		$134.90	$204.17	$309.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $30.90 / $48.98	Professional	26	$21.88	$30.90	$48.98
United Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $173.78 / $257.04	Professional	TC	$112.20	$173.78	$257.04