Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $98.57 / $126.00 / $162.46	Facility	26	$98.57	$126.00	$162.46
Aetna Facility/Professional Professional Modifier Low / Median / High Price $362.32 / $475.00 / $1,372.11	Professional		$362.32	$475.00	$1,372.11
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.29 / $140.00 / $236.99	Professional	26	$85.29	$140.00	$236.99
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $143.93 / $212.50 / $686.06	Professional	52	$143.93	$212.50	$686.06
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $238.28 / $335.00 / $801.32	Professional	TC	$238.28	$335.00	$801.32
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $410.55 / $456.16 / $555.32	Professional		$410.55	$456.16	$555.32
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $85.49 / $96.33 / $115.28	Professional	26	$85.49	$96.33	$115.28
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $323.85 / $359.83 / $469.83	Professional	TC	$323.85	$359.83	$469.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $242.12 / $490.00 / $863.48	Professional		$242.12	$490.00	$863.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.58 / $100.33 / $191.25	Professional	26	$65.58	$100.33	$191.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $173.77 / $369.97 / $683.32	Professional	TC	$173.77	$369.97	$683.32
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $284.81 / $367.40 / $623.51	Professional		$284.81	$367.40	$623.51
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $83.60 / $101.74 / $150.51	Professional	26	$83.60	$101.74	$150.51
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $200.03 / $258.04 / $517.66	Professional	TC	$200.03	$258.04	$517.66
United Facility/Professional Professional Modifier Low / Median / High Price $260.47 / $372.10 / $830.29	Professional		$260.47	$372.10	$830.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.64 / $91.31 / $154.34	Professional	26	$44.64	$91.31	$154.34
United Facility/Professional Professional Modifier TC Low / Median / High Price $190.04 / $281.27 / $621.40	Professional	TC	$190.04	$281.27	$621.40
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $227.85 / $309.85 / $402.81	Professional		$227.85	$309.85	$402.81
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $67.81 / $88.94 / $115.62	Professional	26	$67.81	$88.94	$115.62
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $160.02 / $220.91 / $282.41	Professional	TC	$160.02	$220.91	$282.41