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 / $467.74 / $1,445.44	Professional		$208.93	$467.74	$1,445.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $117.49 / $269.15	Professional	26	$66.07	$117.49	$269.15
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $15.85 / $371.54 / $1,230.27	Professional	52	$15.85	$371.54	$1,230.27
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $281.84 / $660.69	Professional	TC	$125.89	$281.84	$660.69
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $257.04 / $467.74	Professional		$95.50	$257.04	$467.74
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $87.10 / $128.82	Professional	26	$77.62	$87.10	$128.82
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $186.21 / $741.31	Professional	TC	$165.96	$186.21	$741.31
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 / $724.44	Professional		$169.82	$363.08	$724.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $83.18 / $158.49	Professional	26	$54.95	$83.18	$158.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $245.47 / $602.56	Professional	TC	$112.20	$245.47	$602.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $229.09 / $446.68	Professional		$199.53	$229.09	$446.68
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 $131.83 / $151.36 / $309.03	Professional	TC	$131.83	$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 $42.66 / $75.86 / $128.82	Professional	26	$42.66	$75.86	$128.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $204.17 / $501.19	Professional	TC	$125.89	$204.17	$501.19
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