Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $141.25 / $204.17 / $478.63	Facility	26	$141.25	$204.17	$478.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $758.58 / $1,258.93	Professional		$575.44	$758.58	$1,258.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $169.82 / $501.19	Professional	26	$114.82	$169.82	$501.19
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $199.53 / $257.04 / $1,258.93	Professional	52	$199.53	$257.04	$1,258.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $467.74 / $588.84 / $1,023.29	Professional	TC	$467.74	$588.84	$1,023.29
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $707.95 / $1,000.00	Professional		$501.19	$707.95	$1,000.00
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $162.18 / $263.03	Professional	26	$120.23	$162.18	$263.03
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $416.87 / $537.03 / $831.76	Professional	TC	$416.87	$537.03	$831.76
Cigna Facility/Professional Professional Modifier Low / Median / High Price $676.08 / $1,023.29 / $1,479.11	Professional		$676.08	$1,023.29	$1,479.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $199.53 / $295.12	Professional	26	$138.04	$199.53	$295.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $575.44 / $812.83 / $1,174.90	Professional	TC	$575.44	$812.83	$1,174.90
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $741.31 / $1,071.52 / $1,548.82	Professional		$741.31	$1,071.52	$1,548.82
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $177.83 / $338.84	Professional	26	$125.89	$177.83	$338.84
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $616.60 / $870.96 / $1,202.26	Professional	TC	$616.60	$870.96	$1,202.26
Select Health Facility/Professional Professional Modifier Low / Median / High Price $602.56 / $741.31 / $794.33	Professional		$602.56	$741.31	$794.33
Select Health Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $125.89 / $190.55	Professional	26	$117.49	$125.89	$190.55
Select Health Facility/Professional Professional Modifier TC Low / Median / High Price $537.03 / $616.60 / $794.33	Professional	TC	$537.03	$616.60	$794.33
United Facility/Professional Professional Modifier Low / Median / High Price $707.95 / $1,000.00 / $1,513.56	Professional		$707.95	$1,000.00	$1,513.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $204.17 / $323.59	Professional	26	$134.90	$204.17	$323.59
United Facility/Professional Professional Modifier TC Low / Median / High Price $562.34 / $812.83 / $1,174.90	Professional	TC	$562.34	$812.83	$1,174.90