Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $81.68 / $126.00 / $250.74	Facility	26	$81.68	$126.00	$250.74
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $85.00 / $85.00 / $85.00	Facility	53	$85.00	$85.00	$85.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $218.80 / $475.00 / $1,234.42	Professional		$218.80	$475.00	$1,234.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $71.26 / $127.65 / $363.44	Professional	26	$71.26	$127.65	$363.44
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $104.28 / $212.50 / $588.40	Professional	52	$104.28	$212.50	$588.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $180.31 / $335.00 / $595.01	Professional	TC	$180.31	$335.00	$595.01
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $301.88 / $335.42 / $462.88	Professional		$301.88	$335.42	$462.88
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $71.17 / $80.23 / $105.44	Professional	26	$71.17	$80.23	$105.44
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $226.82 / $248.55 / $391.71	Professional	TC	$226.82	$248.55	$391.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $174.99 / $388.65 / $714.62	Professional		$174.99	$388.65	$714.62
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.36 / $83.64 / $162.66	Professional	26	$54.36	$83.64	$162.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $118.13 / $280.00 / $601.89	Professional	TC	$118.13	$280.00	$601.89
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $206.42 / $266.27 / $493.71	Professional		$206.42	$266.27	$493.71
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $69.26 / $84.34 / $125.22	Professional	26	$69.26	$84.34	$125.22
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $136.13 / $175.62 / $372.01	Professional	TC	$136.13	$175.62	$372.01
United Facility/Professional Professional Modifier Low / Median / High Price $196.19 / $280.58 / $654.84	Professional		$196.19	$280.58	$654.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.78 / $76.15 / $145.79	Professional	26	$33.78	$76.15	$145.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $131.94 / $209.41 / $493.23	Professional	TC	$131.94	$209.41	$493.23
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $165.14 / $224.04 / $291.25	Professional		$165.14	$224.04	$291.25
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $56.22 / $73.68 / $95.78	Professional	26	$56.22	$73.68	$95.78
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $108.91 / $150.36 / $192.21	Professional	TC	$108.91	$150.36	$192.21