Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.89 / $126.00 / $151.19	Facility	26	$80.89	$126.00	$151.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $265.95 / $475.00 / $1,320.50	Professional		$265.95	$475.00	$1,320.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $76.48 / $140.00 / $282.00	Professional	26	$76.48	$140.00	$282.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $125.00 / $212.50 / $587.63	Professional	52	$125.00	$212.50	$587.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $233.85 / $335.00 / $972.99	Professional	TC	$233.85	$335.00	$972.99
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $400.65 / $412.56 / $495.98	Professional		$400.65	$412.56	$495.98
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $70.09 / $79.51 / $90.88	Professional	26	$70.09	$79.51	$90.88
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $318.02 / $333.05 / $418.80	Professional	TC	$318.02	$333.05	$418.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $205.42 / $467.95 / $787.22	Professional		$205.42	$467.95	$787.22
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.85 / $82.53 / $161.06	Professional	26	$53.85	$82.53	$161.06
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $149.08 / $335.04 / $632.26	Professional	TC	$149.08	$335.04	$632.26
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $239.93 / $309.51 / $522.28	Professional		$239.93	$309.51	$522.28
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $68.62 / $83.54 / $113.34	Professional	26	$68.62	$83.54	$113.34
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $170.31 / $219.70 / $409.21	Professional	TC	$170.31	$219.70	$409.21
United Facility/Professional Professional Modifier Low / Median / High Price $224.83 / $321.19 / $732.15	Professional		$224.83	$321.19	$732.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.42 / $75.06 / $169.55	Professional	26	$41.42	$75.06	$169.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $166.90 / $253.81 / $618.19	Professional	TC	$166.90	$253.81	$618.19
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $191.94 / $261.14 / $339.48	Professional		$191.94	$261.14	$339.48
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $55.70 / $73.00 / $94.90	Professional	26	$55.70	$73.00	$94.90
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $136.25 / $188.14 / $240.52	Professional	TC	$136.25	$188.14	$240.52