Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $126.00 / $128.06 / $250.74	Facility	26	$126.00	$128.06	$250.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $339.62 / $475.00 / $1,896.73	Professional		$339.62	$475.00	$1,896.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $110.32 / $156.35 / $498.26	Professional	26	$110.32	$156.35	$498.26
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $169.81 / $212.50 / $906.15	Professional	52	$169.81	$212.50	$906.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $269.98 / $335.00 / $1,426.48	Professional	TC	$269.98	$335.00	$1,426.48
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $481.43 / $534.91 / $702.89	Professional		$481.43	$534.91	$702.89
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $115.81 / $123.53 / $162.32	Professional	26	$115.81	$123.53	$162.32
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $370.25 / $411.39 / $548.91	Professional	TC	$370.25	$411.39	$548.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $284.43 / $590.00 / $1,254.83	Professional		$284.43	$590.00	$1,254.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.82 / $131.38 / $251.06	Professional	26	$84.82	$131.38	$251.06
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $196.69 / $421.61 / $1,113.23	Professional	TC	$196.69	$421.61	$1,113.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $335.48 / $432.77 / $771.67	Professional		$335.48	$432.77	$771.67
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $107.93 / $131.58 / $198.72	Professional	26	$107.93	$131.58	$198.72
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $225.83 / $291.32 / $589.27	Professional	TC	$225.83	$291.32	$589.27
United Facility/Professional Professional Modifier Low / Median / High Price $307.02 / $481.36 / $1,076.05	Professional		$307.02	$481.36	$1,076.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.98 / $112.72 / $183.83	Professional	26	$58.98	$112.72	$183.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $216.57 / $353.36 / $821.21	Professional	TC	$216.57	$353.36	$821.21
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $268.38 / $364.26 / $473.54	Professional		$268.38	$364.26	$473.54
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $87.72 / $114.82 / $149.27	Professional	26	$87.72	$114.82	$149.27
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $180.66 / $249.44 / $318.89	Professional	TC	$180.66	$249.44	$318.89