Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.01 / $126.00 / $1,308.67	Facility	26	$75.01	$126.00	$1,308.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $172.37 / $425.00 / $1,168.40	Professional		$172.37	$425.00	$1,168.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.31 / $140.00 / $284.00	Professional	26	$74.31	$140.00	$284.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $261.31 / $261.31 / $261.31	Professional	50	$261.31	$261.31	$261.31
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $123.88 / $212.50 / $580.38	Professional	52	$123.88	$212.50	$580.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $176.33 / $335.00 / $917.81	Professional	TC	$176.33	$335.00	$917.81
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $303.33 / $337.04 / $442.86	Professional		$303.33	$337.04	$442.86
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $64.83 / $74.20 / $97.51	Professional	26	$64.83	$74.20	$97.51
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $236.54 / $262.83 / $354.89	Professional	TC	$236.54	$262.83	$354.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $181.69 / $400.00 / $675.37	Professional		$181.69	$400.00	$675.37
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.90 / $76.44 / $149.31	Professional	26	$49.90	$76.44	$149.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $129.44 / $280.00 / $552.96	Professional	TC	$129.44	$280.00	$552.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $214.33 / $276.49 / $488.00	Professional		$214.33	$276.49	$488.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $63.64 / $77.42 / $106.32	Professional	26	$63.64	$77.42	$106.32
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $149.81 / $193.25 / $381.89	Professional	TC	$149.81	$193.25	$381.89
United Facility/Professional Professional Modifier Low / Median / High Price $193.85 / $288.76 / $675.14	Professional		$193.85	$288.76	$675.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.63 / $74.30 / $158.19	Professional	26	$33.63	$74.30	$158.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $143.02 / $212.07 / $533.92	Professional	TC	$143.02	$212.07	$533.92
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $171.46 / $233.09 / $303.02	Professional		$171.46	$233.09	$303.02
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $51.62 / $67.70 / $88.01	Professional	26	$51.62	$67.70	$88.01
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $119.85 / $165.39 / $211.42	Professional	TC	$119.85	$165.39	$211.42