Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.05 / $19.95 / $30.90	Facility	26	$19.05	$19.95	$30.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $69.18 / $288.40	Professional		$52.48	$69.18	$288.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $21.88 / $77.62	Professional	26	$15.85	$21.88	$77.62
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $28.84 / $48.98 / $104.71	Professional	50	$28.84	$48.98	$104.71
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $44.67 / $74.13	Professional	TC	$36.31	$44.67	$74.13
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $81.28 / $125.89	Professional		$56.23	$81.28	$125.89
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $23.99 / $35.48	Professional	26	$17.38	$23.99	$35.48
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $58.88 / $91.20	Professional	TC	$38.90	$58.88	$91.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $91.20 / $128.82	Professional		$64.57	$91.20	$128.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $26.92 / $39.81	Professional	26	$19.95	$26.92	$39.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $64.57 / $91.20	Professional	TC	$45.71	$64.57	$91.20
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $95.50 / $363.08	Professional		$67.61	$95.50	$363.08
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $26.92 / $117.49	Professional	26	$19.05	$26.92	$117.49
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $69.18 / $245.47	Professional	TC	$48.98	$69.18	$245.47
Select Health Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $67.61 / $72.44	Professional		$60.26	$67.61	$72.44
Select Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $19.05 / $23.99	Professional	26	$17.78	$19.05	$23.99
Select Health Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $48.98 / $48.98	Professional	TC	$42.66	$48.98	$48.98
United Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $87.10 / $138.04	Professional		$58.88	$87.10	$138.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $26.30 / $41.69	Professional	26	$18.62	$26.30	$41.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $58.88 / $97.72	Professional	TC	$40.74	$58.88	$97.72