Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.88 / $47.52 / $69.41	Facility	26	$34.88	$47.52	$69.41
Aetna Facility/Professional Professional Modifier Low / Median / High Price $127.37 / $253.86 / $789.18	Professional		$127.37	$253.86	$789.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.20 / $55.04 / $175.00	Professional	26	$36.20	$55.04	$175.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $58.80 / $64.14 / $349.27	Professional	52	$58.80	$64.14	$349.27
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $83.39 / $175.15 / $332.97	Professional	TC	$83.39	$175.15	$332.97
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $176.86 / $196.52 / $255.48	Professional		$176.86	$196.52	$255.48
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $52.51 / $59.75 / $78.52	Professional	26	$52.51	$59.75	$78.52
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $123.08 / $136.77 / $177.80	Professional	TC	$123.08	$136.77	$177.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.36 / $225.00 / $424.63	Professional		$114.36	$225.00	$424.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.63 / $56.51 / $106.73	Professional	26	$31.63	$56.51	$106.73
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $81.53 / $158.33 / $290.06	Professional	TC	$81.53	$158.33	$290.06
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $134.77 / $173.85 / $296.36	Professional		$134.77	$173.85	$296.36
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $40.34 / $52.76 / $84.12	Professional	26	$40.34	$52.76	$84.12
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $93.87 / $121.09 / $231.35	Professional	TC	$93.87	$121.09	$231.35
United Facility/Professional Professional Modifier Low / Median / High Price $116.46 / $169.76 / $356.71	Professional		$116.46	$169.76	$356.71
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.51 / $46.47 / $76.00	Professional	26	$28.51	$46.47	$76.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $82.97 / $121.22 / $269.37	Professional	TC	$82.97	$121.22	$269.37
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $107.82 / $146.62 / $190.61	Professional		$107.82	$146.62	$190.61
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $32.72 / $42.91 / $55.78	Professional	26	$32.72	$42.91	$55.78
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $75.09 / $103.71 / $132.59	Professional	TC	$75.09	$103.71	$132.59