Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $562.34 / $562.34 / $776.25	Facility	26	$562.34	$562.34	$776.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $537.03 / $1,445.44	Professional		$338.84	$537.03	$1,445.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $134.90 / $338.84	Professional	26	$102.33	$134.90	$338.84
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $169.82 / $331.13 / $426.58	Professional	52	$169.82	$331.13	$426.58
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $309.03 / $645.65	Professional	TC	$234.42	$309.03	$645.65
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $389.05 / $537.03	Professional		$288.40	$389.05	$537.03
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $114.82 / $151.36	Professional	26	$102.33	$114.82	$151.36
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $257.04 / $501.19	Professional	TC	$257.04	$257.04	$501.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $457.09 / $1,000.00	Professional		$316.23	$457.09	$1,000.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $138.04 / $295.12	Professional	26	$102.33	$138.04	$295.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $331.13 / $741.31	Professional	TC	$208.93	$331.13	$741.31
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $416.87 / $707.95	Professional		$354.81	$416.87	$707.95
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $125.89 / $208.93	Professional	26	$109.65	$125.89	$208.93
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $288.40 / $512.86	Professional	TC	$251.19	$288.40	$512.86
United Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $407.38 / $691.83	Professional		$288.40	$407.38	$691.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $125.89 / $208.93	Professional	26	$91.20	$125.89	$208.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $275.42 / $478.63	Professional	TC	$190.55	$275.42	$478.63
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $467.74 / $562.34	Professional		$251.19	$467.74	$562.34
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $141.25 / $158.49	Professional	26	$74.13	$141.25	$158.49
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $331.13 / $398.11	Professional	TC	$177.83	$331.13	$398.11