Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.14 / $59.68 / $87.85	Facility	26	$44.14	$59.68	$87.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $100.86 / $181.84 / $701.52	Professional		$100.86	$181.84	$701.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.15 / $55.49 / $177.44	Professional	26	$44.15	$55.49	$177.44
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $60.90 / $66.72 / $350.76	Professional	52	$60.90	$66.72	$350.76
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $78.25 / $177.61 / $548.44	Professional	TC	$78.25	$177.61	$548.44
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $188.86 / $225.75 / $293.48	Professional		$188.86	$225.75	$293.48
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $53.02 / $55.48 / $69.67	Professional	26	$53.02	$55.48	$69.67
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $122.36 / $172.73 / $224.55	Professional	TC	$122.36	$172.73	$224.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $118.03 / $246.30 / $413.81	Professional		$118.03	$246.30	$413.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.72 / $63.95 / $118.86	Professional	26	$39.72	$63.95	$118.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $82.91 / $168.77 / $302.77	Professional	TC	$82.91	$168.77	$302.77
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $139.63 / $180.14 / $302.77	Professional		$139.63	$180.14	$302.77
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $50.62 / $59.05 / $97.59	Professional	26	$50.62	$59.05	$97.59
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $88.29 / $113.89 / $218.92	Professional	TC	$88.29	$113.89	$218.92
United Facility/Professional Professional Modifier Low / Median / High Price $125.17 / $194.67 / $371.22	Professional		$125.17	$194.67	$371.22
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.05 / $59.19 / $96.57	Professional	26	$29.05	$59.19	$96.57
United Facility/Professional Professional Modifier TC Low / Median / High Price $86.69 / $123.84 / $254.70	Professional	TC	$86.69	$123.84	$254.70
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $111.71 / $151.38 / $196.81	Professional		$111.71	$151.38	$196.81
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $41.08 / $53.85 / $70.01	Professional	26	$41.08	$53.85	$70.01
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $70.63 / $97.54 / $124.70	Professional	TC	$70.63	$97.54	$124.70