Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $83.18 / $125.89 / $173.78	Facility	26	$83.18	$125.89	$173.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $478.63 / $1,348.96	Professional		$208.93	$478.63	$1,348.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $125.89 / $281.84	Professional	26	$67.61	$125.89	$281.84
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $123.03 / $512.86 / $870.96	Professional	52	$123.03	$512.86	$870.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $275.42 / $707.95	Professional	TC	$123.03	$275.42	$707.95
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $269.15 / $501.19	Professional		$87.10	$269.15	$501.19
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $95.50 / $131.83	Professional	26	$81.28	$95.50	$131.83
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $186.21 / $446.68	Professional	TC	$165.96	$186.21	$446.68
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $114.82 / $114.82 / $114.82	Facility	26	$114.82	$114.82	$114.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $363.08 / $676.08	Professional		$169.82	$363.08	$676.08
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $85.11 / $162.18	Professional	26	$53.70	$85.11	$162.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $245.47 / $562.34	Professional	TC	$109.65	$245.47	$562.34
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $229.09 / $457.09	Professional		$194.98	$229.09	$457.09
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $77.62 / $107.15	Professional	26	$69.18	$77.62	$107.15
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $151.36 / $309.03	Professional	TC	$128.82	$151.36	$309.03
United Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $288.40 / $630.96	Professional		$190.55	$288.40	$630.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $75.86 / $128.82	Professional	26	$45.71	$75.86	$128.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $199.53 / $489.78	Professional	TC	$125.89	$199.53	$489.78
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $234.42 / $316.23	Professional		$199.53	$234.42	$316.23
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $81.28 / $107.15	Professional	26	$70.79	$81.28	$107.15
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $151.36 / $208.93	Professional	TC	$128.82	$151.36	$208.93